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Hyperabduction Syndrome

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1. Hyperabduction Syndrome

Hyperabduction Syndrome Hyperabduction Syndrome Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Hyperabduction Syndrome Hyperabduction (...) Syndrome Aka: Hyperabduction Syndrome From Related Chapters II. Mechanism Prolonged hyperabduction Occurs during sleep Overhead painting Compression of neurovascular structures Pass under coracoid process and pectoralis minor III. Symptoms Extremity Numbness and s Less severe than other forms of thoracic outlet IV. Signs V. Management Prevent arm hyperabduction at night Gauze strip tied to wrist and attached to foot of bed Images: Related links to external sites (from Bing) These images are a random

2018 FP Notebook

2. Hyperabduction Syndrome

Hyperabduction Syndrome Hyperabduction Syndrome Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Hyperabduction Syndrome Hyperabduction (...) Syndrome Aka: Hyperabduction Syndrome From Related Chapters II. Mechanism Prolonged hyperabduction Occurs during sleep Overhead painting Compression of neurovascular structures Pass under coracoid process and pectoralis minor III. Symptoms Extremity Numbness and s Less severe than other forms of thoracic outlet IV. Signs V. Management Prevent arm hyperabduction at night Gauze strip tied to wrist and attached to foot of bed Images: Related links to external sites (from Bing) These images are a random

2015 FP Notebook

3. Thoracic outlet syndrome

Thoracic outlet syndrome Thoracic outlet syndrome - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Thoracic outlet syndrome Last reviewed: February 2019 Last updated: March 2018 Summary Compression of 1 or more of the neurovascular structures traversing the superior aperture of the chest. May affect neurological or vascular structures, or both, depending on the component of the neurovascular bundle predominantly (...) compressed. Types include neurological, arterial, venous, and neurovascular/combined, and patients may present with signs and symptoms of nerve, vein, or artery compression or any combination of these. Neurological is the most common, while arterial, which is relatively rare, is arguably the most important to recognise owing to the risk of ischaemia. Neurological thoracic outlet syndrome primarily develops spontaneously in people in their late teens up to the age of 60 years, and is more common in women

2018 BMJ Best Practice

4. Thoracic Outlet Syndrome.

Thoracic Outlet Syndrome. Date of origin: 2014 ACR Appropriateness Criteria ® 1 Imaging in the Diagnosis of Thoracic Outlet Syndrome American College of Radiology ACR Appropriateness Criteria ® Clinical Condition: Imaging in the Diagnosis of Thoracic Outlet Syndrome Radiologic Procedure Rating Comments RRL* X-ray chest 8 ? MRA chest without and with IV contrast 8 O CTA chest with IV contrast 7 ??? MRI chest without IV contrast 7 O US duplex Doppler subclavian artery and vein 6 O Digital (...) subtraction angiography upper extremity 5 ? CT chest without IV contrast 3 ??? MRA chest without IV contrast 2 O Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level ACR Appropriateness Criteria ® 2 Imaging in the Diagnosis of Thoracic Outlet Syndrome IMAGING IN THE DIAGNOSIS OF THORACIC OUTLET SYNDROME Expert Panels on Vascular Imaging, Neurologic Imaging and Thoracic Imaging: John M. Moriarty, MB, BCh 1 ; Dennis F. Bandyk, MD 2

2019 American College of Radiology

5. Nonarticular Rheumatism/Regional Pain Syndrome (Treatment)

and prepatellar bursitis. Never inject into the Achilles tendon because of the risk of rupture. Bursal aspiration and sometimes sclerosis with tetracycline Assessment of home and workplace habits such as posture and repetitive motion Alterations in sleep position may benefit persons with neurovascular entrapment such as thoracic outlet syndrome (ie, avoiding arm hyperabduction) and carpal tunnel syndromes (avoiding wrist flexion). Women with heavy pendulous breasts may need brassieres with proper support (...) Nonarticular Rheumatism/Regional Pain Syndrome (Treatment) Nonarticular Rheumatism/Regional Pain Syndrome Treatment & Management: Medical Care, Surgical Care, Consultations Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache

2014 eMedicine.com

6. Thoracic Outlet Syndrome

thoracic outlet syndrome. The Adson maneuver consists of depression of the patient's shoulder with his or her head turned to the symptomatic side. Other positions for imaging include hyperabduction of the arm and the costoclavicular maneuver; the clinical examinations with these positions are equivalent (see the images below). A venogram that was obtained in a 28-year-old man complaining of intermittent right arm swelling, taken with his right arm in the anatomic (neutral) position. A venogram of a 28 (...) Thoracic Outlet Syndrome Thoracic Outlet Syndrome Imaging: Practice Essentials, Radiography, Computed Tomography Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDE4NjcwLW92ZXJ2aWV3 processing > Thoracic Outlet

2014 eMedicine Radiology

7. Vascular Occlusive Syndromes of the Upper Extremity (Follow-up)

Vascular Occlusive Syndromes of the Upper Extremity (Follow-up) Vascular Occlusive Syndromes of the Upper Extremity Treatment & Management: Medical Care, Surgical Care Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTI0MTA4OC10cmVhdG1lbnQ= processing > Vascular Occlusive Syndromes of the Upper Extremity Treatment & Management Updated: Feb 22, 2017 Author: Bradon J Wilhelmi, MD; Chief Editor: Harris Gellman, MD Share Email Print Feedback Close Sections Sections Vascular Occlusive Syndromes of the Upper Extremity Treatment Medical Care Chronic vascular occlusive diseases Chronic occur secondary to the following: Repetitive trauma Atherosclerosis Proximal embolic events Systemic diseases, such as collagen vascular disease

2014 eMedicine Surgery

8. Vascular Occlusive Syndromes of the Upper Extremity (Treatment)

Vascular Occlusive Syndromes of the Upper Extremity (Treatment) Vascular Occlusive Syndromes of the Upper Extremity Treatment & Management: Medical Care, Surgical Care Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTI0MTA4OC10cmVhdG1lbnQ= processing > Vascular Occlusive Syndromes of the Upper Extremity Treatment & Management Updated: Feb 22, 2017 Author: Bradon J Wilhelmi, MD; Chief Editor: Harris Gellman, MD Share Email Print Feedback Close Sections Sections Vascular Occlusive Syndromes of the Upper Extremity Treatment Medical Care Chronic vascular occlusive diseases Chronic occur secondary to the following: Repetitive trauma Atherosclerosis Proximal embolic events Systemic diseases, such as collagen vascular disease

2014 eMedicine Surgery

9. The Effectiveness of Diagnosis and Treatment of Thoracic Outlet Syndrome

for a decrease of symptoms and even eradication of the syndrome altogether. Although diagnosis and treatment of TOS is common in osteopathic medicine, the effectiveness of the diagnostic special tests and treatment has not been thoroughly investigated. This study aims to examine the effectiveness of the special tests (Adson's, Wright's hyperabduction and Halstead maneuver) in diagnosing a change in blood flow through the arteries of the upper arm compared to evaluation with Doppler ultrasound to measure (...) The Effectiveness of Diagnosis and Treatment of Thoracic Outlet Syndrome The Effectiveness of Diagnosis and Treatment of Thoracic Outlet Syndrome - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more

2011 Clinical Trials

10. Is rib resection necessary for relief of thoracic outlet syndrome? (PubMed)

Is rib resection necessary for relief of thoracic outlet syndrome? Between 1966 and 1975, 425 patients with thoracic outlet symptoms were studied: 146 operative procedures were carried out in 103 of these patients. Division of soft tissues, only, in 129 cases offered relief of symptoms. In 10 cases bone resections (four cervical ribs, one second rib, one clavicle, and four first ribs) were done in an attempt to relieve the outlet problems. Preoperative evaluation included neurological (...) consultation, x-rays of the neck and chest, detailed non-invasive oscillographic recordings of arterial flow during various outlet maneuvers, angiograms and in many instances electromyograms and nerve conduction studies. The axillary surgical approach to be various compression areas was preferred in that hyperabduction of the arm and costoclavicular maneuvers could be carried out under direct observation of the involved vessels. Accurate appraisal of the compression point could be assessed before and after

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1977 Annals of Surgery

11. Bilateral upper extremity deep vein thromboses: not an effortless diagnosis

primary UEDVTs and how they can present without any of the classic thoracic outlet syndrome findings Case A healthy 53-year-old man presented with a 10-day history of left-sided neck and arm pain, and left arm swelling. On exam, pulses, strength, and sensation were unremarkable and symmetrical bilaterally. All laboratory studies were within normal limits. Ultrasonography with doppler showed several clots in the left subclavian, axillary, and brachial veins along with the right basilic and subclavian (...) , a venous thoracic outlet syndrome (venous TOS or VTOS) [4]. The resulting thrombosis was first described by Paget [5] and then by Schrötter [6], [7]. And finally, given this pathology was often observed in otherwise healthy adults with a history of extensive use of their upper extremities, the term effort thrombosis is also used [4]. Despite all the different terms used to describe this condition, the pathophysiology is one and the same: anatomic compression of the subclavian vein at the thoracic

2019 Clinical Correlations

12. CRACKCast E087 – Peripheral Arteriovascular Disease

syndrome = shoulders moved back/down due to muscle hypertrophy/trauma Hyperabduction syndrome = when the arms are positioned in a hyper-abducted position and the pectoralis minor muscle compresses the neurovascular Bundle. Wisecracks 1) Describe Buerger’s sign and the Ankle-Brachial Index (ABI) Buerger’s Sign Provides evidence of severe advanced arterial ischemia: Place the patient supine Raise their legs to 45 degrees Then lift their feet > 35 cm above the right atrium. IF their foot becomes pale (...) outlet syndrome. Shownotes – Rosen’s In Perspective This chapter covers the diseases that affect the medium and small arteries in the body (ie. not the aorta, innominate, common carotid, subclavian, or pulmonary arteries). While not featured in the podcast, we’re going to take a deeper dive into the 3 layers of an arterial wall here in the shownotes…because this is going to be a beast of a podcast! Describe the 3 wall layers of an artery: Tunica: Intima: the inner endothelial lining that protects

2017 CandiEM

13. Improved functional outcome in NTOS patients following resection of the subclavius muscle with radiological signs of nerve impingement: indication of participation of the subclavius in brachial plexus compression. (PubMed)

Improved functional outcome in NTOS patients following resection of the subclavius muscle with radiological signs of nerve impingement: indication of participation of the subclavius in brachial plexus compression. OBJECTIVEBoth clinical and radiological reports have suggested that the subclavius, a muscle in the costoclavicular space of the thoracic outlet, participates in neurogenic thoracic outlet syndrome (NTOS) in some instances, especially during movements narrowing the costoclavicular (...) postoperative DASH scores and self-assessments but better subscale scores (9.50 ± 2.76 vs 11.94 ± 2.87, p = 0.0005). Postoperative MRI on hyperabduction showed that the brachial plexus became surrounded by normal fat tissue in the costoclavicular space in the diving group but still had signs of impingement from the untreated subclavius muscle in the sparing group. This observation agreed with a better functional recovery in terms of overhead activities in the dividing group, which was reflected by better

2018 Journal of Neurosurgery

14. Does Shoulder Stabilizations Stabilize Shoulders?

motion capture and computed tomography. Condition or disease Intervention/treatment Phase Shoulder Dislocation Shoulder Pain Joint Instability Syndrome Procedure: Shoulder Stabilization Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 11 participants Intervention Model: Single Group Assignment Masking: None (Open Label) Primary Purpose: Diagnostic Official Title: Does Shoulder Stabilizations Stabilize Shoulders (...) surgery Contraindications for computed tomography Non-traumatic onset Hyperlaxity. The latter was defined as more than 85° of external rotation at the elbow against the waist{Coudane, 2000 #3124} or hyperabduction by more than 105°.{Gagey, 2001 #1915} Contacts and Locations Go to No Contacts or Locations Provided More Information Go to Publications: Layout table for additonal information Responsible Party: Adrien Schwitzguebel, MD, La Tour Hospital ClinicalTrials.gov Identifier: Other Study ID Numbers

2016 Clinical Trials

15. Subclavian Artery Thrombosis (Overview)

or because of atherosclerotic changes to the vessel. Embolic phenomena and hypercoagulable states are also contributing factors. Symptoms occur secondary to lack of blood flow to the affected extremity. To maintain blood supply to the extremity, blood is naturally rerouted from the vertebral, carotid, and internal mammary arteries, producing the various steal syndromes. Subclavian artery thrombosis is common in young athletic individuals who exert a significant amount of upper body activity. [ ] Sudden (...) hyperabduction of the extremity. One site is where the axillary artery passes posterior to the pectoralis minor and beneath the coracoid process. The other point is where the artery courses between the clavicle and the first rib. Fibrous tissue proliferation in this area can impose extrinsic compression on the vessel. (See the image below.) The anatomy of the subclavian artery in the thoracic outlet. Aberrant origins of the subclavian artery off the aortic arch can be a cause of subclavian artery occlusion

2014 eMedicine Surgery

16. Upper Extremity Occlusive Disease (Overview)

blood vessels have not formed, and perfusion drops rapidly below a critical threshold level, which results in persistent pain and tissue necrosis. Limb pressure is generally less than 30 mm Hg. Doppler tones cannot be heard in the digital vessels. The pathophysiology of Raynaud syndrome is unknown. Precapillary smooth muscle cells constrict in an abnormal response to cold stimulation or emotional stress. [ ] Sympathetic nervous system adrenoreceptor function and number are believed to be altered (...) , , penetrating, [ ] blunt, or iatrogenic) Arteritis (eg, Takayasu arteritis or arteritis) Irradiation Embolic (eg, cardiac or thoracic outlet in origin, including bacterial endocarditis, microemboli from ascending aorta, or ) Digital artery occlusion (see the image below) Connective-tissue disease - ; (chondrocalcinosis, Raynaud phenomenon, esophageal motility disorder, sclerodactyly, and telangiectasia) syndrome; and mixed connective-tissue disease Buerger disease Hypersensitivity angitis Hematologic

2014 eMedicine Surgery

17. Upper Extremity Occlusive Disease (Diagnosis)

blood vessels have not formed, and perfusion drops rapidly below a critical threshold level, which results in persistent pain and tissue necrosis. Limb pressure is generally less than 30 mm Hg. Doppler tones cannot be heard in the digital vessels. The pathophysiology of Raynaud syndrome is unknown. Precapillary smooth muscle cells constrict in an abnormal response to cold stimulation or emotional stress. [ ] Sympathetic nervous system adrenoreceptor function and number are believed to be altered (...) , , penetrating, [ ] blunt, or iatrogenic) Arteritis (eg, Takayasu arteritis or arteritis) Irradiation Embolic (eg, cardiac or thoracic outlet in origin, including bacterial endocarditis, microemboli from ascending aorta, or ) Digital artery occlusion (see the image below) Connective-tissue disease - ; (chondrocalcinosis, Raynaud phenomenon, esophageal motility disorder, sclerodactyly, and telangiectasia) syndrome; and mixed connective-tissue disease Buerger disease Hypersensitivity angitis Hematologic

2014 eMedicine Surgery

18. Subclavian Artery Thrombosis (Diagnosis)

or because of atherosclerotic changes to the vessel. Embolic phenomena and hypercoagulable states are also contributing factors. Symptoms occur secondary to lack of blood flow to the affected extremity. To maintain blood supply to the extremity, blood is naturally rerouted from the vertebral, carotid, and internal mammary arteries, producing the various steal syndromes. Subclavian artery thrombosis is common in young athletic individuals who exert a significant amount of upper body activity. [ ] Sudden (...) hyperabduction of the extremity. One site is where the axillary artery passes posterior to the pectoralis minor and beneath the coracoid process. The other point is where the artery courses between the clavicle and the first rib. Fibrous tissue proliferation in this area can impose extrinsic compression on the vessel. (See the image below.) The anatomy of the subclavian artery in the thoracic outlet. Aberrant origins of the subclavian artery off the aortic arch can be a cause of subclavian artery occlusion

2014 eMedicine Surgery

19. The Approach to the Painful Joint (Treatment)

of the joint. The joint disease may occur as a result of either (1) cartilage or meniscal damage with or without concomitant alterations in the structure of the subchondral bone or (2) alterations in joint anatomy caused by congenital, developmental, metabolic, or past inflammatory diseases. Arthralgia is characterized by joint tenderness, but abnormalities of the joint cannot be identified. Such patients may have a syndrome of altered pain sensation (eg, fibromyalgia) or an early rheumatic syndrome whose (...) is indicative of synovial hypertrophy. Percuss the volar aspect of the wrist; elicitation of paresthesias in the median nerve distribution is indicative of carpal tunnel syndrome. In the elbow, assess for flexion deformity (ie, inability to fully extend); this may be an early sign of an inflammatory arthritis. Palpate for soft tissue swelling of synovitis in fossae between the olecranon and lateral or medial epicondyles. Assess for subcutaneous nodules in olecranon bursae and over the extensor surfaces

2014 eMedicine.com

20. The Approach to the Painful Joint (Overview)

of the joint. The joint disease may occur as a result of either (1) cartilage or meniscal damage with or without concomitant alterations in the structure of the subchondral bone or (2) alterations in joint anatomy caused by congenital, developmental, metabolic, or past inflammatory diseases. Arthralgia is characterized by joint tenderness, but abnormalities of the joint cannot be identified. Such patients may have a syndrome of altered pain sensation (eg, fibromyalgia) or an early rheumatic syndrome whose (...) is indicative of synovial hypertrophy. Percuss the volar aspect of the wrist; elicitation of paresthesias in the median nerve distribution is indicative of carpal tunnel syndrome. In the elbow, assess for flexion deformity (ie, inability to fully extend); this may be an early sign of an inflammatory arthritis. Palpate for soft tissue swelling of synovitis in fossae between the olecranon and lateral or medial epicondyles. Assess for subcutaneous nodules in olecranon bursae and over the extensor surfaces

2014 eMedicine.com

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