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1 Skin Temperature of the Hand in Vascular Test Position in Patients with Thoracic Outlet Syndrome By T. Imagama, S. Hattori, M. Oyama, H. Hayakawa and Y. Azuma Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, Ube Shi, Japan (Director: Prof. S. Hattori) Dullness, cold sensation and swelling of the upper limb are popular symptoms in patients with thoracic outlet syndrome (TOS). These symptoms seem to come from vascular; either arterial or venous, disorders of the upper lim. This is to describe hemodynamic study in measuring skin temperature of the hand in various positions of the upper limb in comparison between patients with TOS and normal persons. There were 79 cases in 59 patients with TOS, in which conservative treatment was taken in 65 cases in 45 patients and first rib resection was performed on 14 cases in 14 patients, and 28 cases in 14 normal persons. Patient or person was kept rest for 30 minutes before the test in room temperature at Results; 1) Skin temperature at rest in patients are lower in the affected side than in the normal side. As the temperatures show lower, occurrence of severe cases in symptoms seems to increase. 2) Skin temperatures are lowest in abduction-external rotation position and Wright's position among the various position of the upper limb. 3) After cold stimulation, skin temperatures of the affected side become lower rapidly and recover quite slowly. 4) In cases of first rib resection, skin temperature is higher after operation than before operation. -46-
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4 (整 形 外 科 と災 害 外 科 第27巻 第4号 1978) 567 Fig.Ⅱ た もの7例,逆 に患 側 が高 か った もの3例 で あ り,1 の 肢位 で 最 も下 降 し,Edenの 肢位 で は安 静 時皮 膚 温 に近 い値 を 示 す 例 を 除 きす べ て術 後 皮 膚 温 の上 昇 が み られ た. (5)本 症 に寒 冷刺 激 を 加 え る と,対 照 群 に比 し両 側 ま と め 共 冷却 され や す い傾 向を 示 した.し か し患側 と健 側 で 胸 郭 出 口症 候 群 の 病 態把 握 の た め,胸 郭 出 口症 候 群 で 保 存 的加 療 例45例65側,第1肋 骨 切 除例14例14 た これ ら30分 後 の 回復 率 で は 対 照 群 に比 し 著 明 に そ 側,お よ び対 照 群 と して頸 肩 上 肢 に全 く症 状 を 有 しな い正 常人14例 のThermogramを 検 討 した. に健側 よ り高 い 症例 もみ られ,本 症 の皮 膚 温 は一 概 に低 下 す る と は言 え な い. (2)患 側 が 健 側 よ り 低 下 した 症 例14例 の 回復 率 は低 下 して い る. (6)上 記所 見 よ り片 側 例 で の健 側 は無症 状 で も本 症 (1)本 症 の安 静 時 皮 膚温 は,患 側 が健 側 よ り低 下 す る傾 向 を示 す が,逆 は,患 側 の方 が そ の程 度 はや や 強 い傾 向 を 示 した.ま の何 らか の素 因 を有 して い る もの と思 わ れ る. (7)第1肋 骨 切 除 例 につ い て の術 前 術 後 の皮 膚 温 を 観 察 し,術 後 自覚 症 状 の改 善 と共 に皮 膚 温 の回 復 を と高 い症例 認 め た. 10例 の 自覚 症 状 の 程度 を 上 肢 症 状,肩 甲 部 症 状 に分 文 けて検 討 す る と,い ず れ も患 側 が低 下 す る症 例 に重 症 例 が多 か っ た. (3)冷 感 を 有 す る 患者 は皮 膚 温 は低 下 す るが,冷 感 の程 度 と皮 膚 温 の低 下 の度 合 との間 に は密 接 な 関 連 は み られ なか った, (4)脈 管 テ ス ト肢 位 で の 皮 膚 温 は上 昇 す る例 もみ ら れ るが,一 1)渥 美和 彦:外 科 にお け る サ ー モ グ ラ フ ィー.現 代 外 科学 大 系.24: ,中 山 書 店, ) Barcroft, H. and Edholm, 0. G. : The Effect of Temperature on Blood Flow and Deep Temperature in the Human Forearm. J. Physiol., 102: 5-20, )遠 般 的 に は外 転 外 旋位 に て下 降 し,Wright -49- 献 藤 紀 他:頸 肩腕 症候 群 に お け る サー モ グ
5 5) Funaki, H.: Mode of Change in Skin Temperature under Exposure to Cold. J. Kyoto Pref. Univ. Med., 83: , ) Funaki, H. and Sato, S.: Change in Skin Temperature of Finger Exposed to Heat- Hunting Temperature Reaction to Heat- (Preliminary Report). J. Kyoto Pref. Univ. Med., 83: , ) Sandrow, R. F., et al.: The Use of Thermography in the Early Diagnosis of Neuropathic Arthropathy in the Feet of Diabetics. Clin. Orthop., 88: 31-33,
Mechanism of Vascular Tests in Thoracic Outlet Syndrome (Clinical and Anatomical Stndy) By T. Imagama, S. Hattori, M. Oyama, S. Kawai, Y. Azuma, Y. Sh
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