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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1 Mechanism of Vascular Tests in Thoracic Outlet Syndrome (Clinical and Anatomical Stndy) By T. Imagama, S. Hattori, M. Oyama, S. Kawai, Y. Azuma, Y. Shigetonmi, H. Oda, Y. Inokawa and T. Tahara Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, Ube Shi, Japan (Director: Prof. S. Hattori) Vascular tests for thoracic outlet syndrome are considered to be one of the important diagnostic aid in order to determine the localization and the severity of neurovascular lesion at the thoracic outlet region. However, the mechanism and significance of vascular tests are still unclear. This is to report our clinical and autopsial study to try to clarify the exact meanings of each vascular test. Materials are 72 cases in 48 patients with thoracic outlet syndrome (46 cases in 39 patients recieved first rib resection) and 21 cases of exploration in autopsy. Positive Adson's test, although the incidence is quite low, may suggest severe lesion at the scalen triangle. Eden's test indicate lesions at the costo-clavicular space. In this positive the clavicle moves most to the posteromedial direction among the various positions. Abduction-external rotation test and Wright's test show neurovascular compression mainly at the costo-clavicular region and partly at the scalen, triangle. These positions make the neurovascular bundle tracted foward the lateral. Compression at the subcoracoideal region is not the main cause in Wright's test. -41-
2 Table 1 Rate of Positive Vascular Test and Plethysmography (48 Patients, 72 Cases)
3 (整 形 外 科 と 災 害 外 科 器 が4mmま 第27巻 第4号 1978) 561 率 は低 下 して い た.そ の機 序 につ い て,新 鮮 屍体 を用 で 計 測 可 能 な た め)(Fig.Ib). 以 上 手 術 所見,局 所 解 剖 所見 か ら,本 症 は斜 角筋 三 い 検討 す る と,鎖 骨 は胸 鎖関 節 を 支点 と して,後 内側 角部 お よ び肋 鎖 間 隙部 の狭 い症例 が多 く,ま た この両 方 に移 動 し,肋 鎖 間 は著 明 に狭 小化 し,ま た斜 角筋 三 角部 を 直 接 前 方 か ら圧 迫 す るが,そ の程 度 は軽度 で 神 者 が合 併 して発 生 して い る症例 が多 い. Adsonテ ス トに つ い て: 経 血 管 束 の 緊 張 は あ ま り強 くな らな い(Fig.Ⅱa). 障 害 部位 別 に各 脈 管 テ ス トの 陽性 率 を み る と,斜 角 筋 三 角 部 の み の障 害 例 は8側 み られ,こ の うち2側25 %にAdsonテ 例10側 ス トが 陽性 で,肋 鎖 間 隙部 の み の障 害 に はAdsonテ ス ト陽性 例 はみ られ なか った. 従 って本 テ ス トが 陽 性 の 場 合,斜 角筋 三 角 部 の 障 害 を意 味 す る もの と思 わ れ る.し か しそ の 陽性 率 が著 明 に低 い とこ ろか ら,そ の障 害 が 高度 で あ る場 合 の み 陽 性 を示 す もの と考 え る.そ の機序 に つ い て は,手 術 所見,局 所 解 剖 所 見 か ら頸 部 を 同側 に回旋 して も前斜 角筋 の緊 張 は あ ま り著 明 で な く,前 斜 角 筋 は呼 吸筋 で あ る ので,深 吸 気 させ る こ と によ り前 斜 角 筋 の 緊 張 が 強 くな り,斜 角筋 三角 部 の狭 小化 を来 す もの と思 わ れ る. Edenテ ス トに つ いて: 本 テ ス トの場 合,肋 鎖 間 隙部 の障 害 例 にそ の 陽性 率 が高 く,斜 角筋 三 角部 の みの 障 害例 で は25%と 陽性 Fig.II -43- 従 って 本 テ ス ト陽性 の 場 合,肋 鎖間 隙 部 の 狭小 化 に よ る神 経 血管 束 の 障害 が 考 え られ る. 外 転 外 旋 位 テ ス トに つ い て: 斜 角筋 三 角部 お よび 肋 鎖 間隙 部 の い ず れ の 障 害 の
4
5 1) Adson, A. W.: Surgical Treatment for Symptoms Produced by Cervical Rib and the Scalenus Anticus Muscle. Surg.Gyn. Obst., 85: , ) Allen, E. V.: Thromboangiitis Obliterans. Am. J. M. Sc., 178: , ) Eden, K. C.: The Vascular Complications of Cervical Ribs and First Thoracic Rib Abnormalities. Brit. J. Surg., 27: , ) Nelson, R. M. and Davis R. W.: Thoracic Outlet Compression Syndrome., Ann. Thorac. Surg. 8: , ) Roos, D. B.: Experience with First Rib Resection for Thoracic Outlet Syndrome. Ann. Surg., 173: , ) Wright, I. S.: The Neuro-Vascular Syndrome Produced by Hyperabduction of the Arms. Amer. Heart. J., 29: 1-19, 1945.
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
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