RESUMEN
El síndrome del opérculo torácico (SOT) es una condición causada por la compresión de las estructuras neurovasculares en su paso entre cuello y tórax. Se clasifica en vascular y neurogénico. Si las pruebas electrofisiológicas no son positivas, se subclasifica como neurogénico inespecífico. Este último constituye entre el 95 y el 98 % de los casos, pero aún no están claros sus criterios diagnósticos. En el presente artículo se revisan los principales aspectos a tener en cuenta durante el examen clínico para guiar el diagnóstico de los pacientes con SOT neurogénico inespecífico, como sintomatología, factores desencadenantes, diagnóstico diferencial, escalas de valoración y factores psicosociales
Thoracic outlet syndrome (SOT) is a controversial condition to this day, caused by compression of neurovascular structures in their passage between the neck and thorax. It is classified as vascular and neurogenic. If the electrophysiological tests are not positive it is subclassified as nonspecific neurogenic. This is between 95-98 % of cases, but its diagnostic criteria are not yet clear. The main aspects to be taken into account during the clinical examination are reviewed to guide the diagnosis of patients with nonspecific neurogenic SOT, such as symptoms, triggers, differential diagnosis, assessment scales and psychosocial factors
Asunto(s)
Humanos , Síndrome de la Costilla Cervical/diagnóstico , Radiculopatía/diagnóstico , Degeneración del Disco Intervertebral/diagnóstico , Dolor de Cuello/diagnóstico , Síndrome de la Costilla Cervical/clasificación , Diagnóstico Diferencial , Síndromes de Compresión Nerviosa/diagnósticoRESUMEN
O estudo das relaçöes mente-corpo é um dos termos que vem assumindo progressiva importância no contexto da medicina atual, possibilitando uma nova visäo sobre a patologia. O maior erro reside no fato que há profissionais relacionados com o corpo, e profissionais relacionados com a mente. Entretanto, mente e corpo é uma unidade indivisível. Desta forma, a näo separaçäo tem como vantagem possibilitar melhor conhecimento da influência psicossomática em doenças físicas, possibilitando melhor aplicaçäo das técnicas de tratamento. O objetivo deste trabalho foi pesquisar o maior número de pessoas relacionadas com a patologia e promover uma nova abordagem perante o paciente portador de doença psicossomática
Asunto(s)
Medicina Psicosomática/métodos , Síndrome de la Costilla Cervical/diagnóstico , Terapias Complementarias , Especialidad de Fisioterapia , Especialidad de Fisioterapia/estadística & datos numéricos , Medicina Psicosomática , Síndrome de la Costilla Cervical/clasificación , Síndrome de la Costilla Cervical/etiología , Síndrome de la Costilla Cervical/terapia , Trastornos Psicofisiológicos/diagnóstico , Trastornos Psicofisiológicos/terapiaRESUMEN
Subclavian artery compression by a cervical rib is an uncommon but potentially disabling condition. A series of 12 patients with 15 arterial lesions is reviewed and a staging system proposed to provide guidelines for managing patients with this condition. Stage I lesions have only arterial stenosis and minor poststenotic dilatation and are managed by thoracic outlet decompression, usually consisting of cervical rib resection. Stage II lesions have intrinsic arterial damage usually with subclavian aneurysm formation and require rib resection, aneurysmectomy, and arterial reconstruction. Stage III lesions present with distal thromboembolic complications and require thrombectomy or embolectomy in addition to thoracic outlet decompression and arterial reconstruction. The anatomic and pathophysiologic bases of the syndrome are reviewed and clinical and angiographic examples of each stage are presented.
Asunto(s)
Síndrome de la Costilla Cervical/clasificación , Síndrome del Desfiladero Torácico/clasificación , Adulto , Aneurisma/etiología , Aneurisma/cirugía , Prótesis Vascular , Síndrome de la Costilla Cervical/cirugía , Endarterectomía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Vena Safena/trasplante , Arteria Subclavia , Trombosis/etiología , Trombosis/cirugíaRESUMEN
A series of 38 patients with thoracic outlet syndrome caused by a cervical rib is reviewed after a postoperative follow-up period of 3 to 24 years. The outcome of the operation (anterior scalenotomy and partial to subtotal removal of the cervical rib) is not considered wholly satisfactory; three causes for this were identified: excessive duration of symptoms (mean almost 6 years), insufficient patient work-up and inadequacy of the incomplete removal of the cervical rib. In the presence of a cervical rib, other possible causes of compression of the neurovascular supply to the upper limb should always be considered.