Abstract
Arterial thoracic outlet syndrome (TOS) can be difficult to diagnose clinically. Recently,
Magnetic Resonance Angiography (MRA) has been used to assist in the diagnosis of arterial
TOS. The purpose of this article is to survey the current literature to establish
the evidence for or against the use of MRA in the diagnosis of arterial TOS. The evidence-based
search was conducted using PubMed, PEDro, Hooked on Evidence, EBM Journals, Ovid,
Cochrane, and E medicine. The studies were graded as to the strength of recommendation
and to the actual level of evidence. Statistics were calculated when sufficient data
were present. The search yielded a total of seven studies. The studies received grades
of recommendation that ranged from B to D. The current evidence in support of MRA
as a valid test for diagnosing arterial TOS is weak and studies are not based on strong
design.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- MRI scanning in brachial plexus neuropathy.Australas Radiol. 1991; 35: 379-381
- Thoracic outlet syndromes and MRI.Brain. 1995; 118: 819-821
- The anatomy of the brachial plexus as displayed by magnetic resonance imaging: technique and application.J Natl Med Assoc. 1995; 87: 489-498
- Compromising abnormalities of the brachial plexus as displayed by magnetic resonance imaging.Clin Anat. 1995; 8: 1-16
- [Exploration of the thoracic outlet syndrome: contribution of MRI].Rev Med Interne. 1999; 20: 478S-480S
- MRI of the brachial plexus: a review of 51 cases.Comput Med Imaging Graph. 1993; 17: 45-50
- Three-dimensional MR angiography in the evaluation of thoracic outlet syndrome.AJR Am J Roentgenol. 1999; 173: 1005-1008
- Thoracic outlet syndrome in a throwing athlete diagnosed with MRI and MRA.J Magn Reson Imaging. 1997; 7: 598-599
- MR angiography of thoracic outlet syndrome.J Comput Assist Tomogr. 1992; 16: 475-477
- Thoracic outlet syndromes and magnetic resonance imaging.Brain. 1993; 116: 823-841
- Diagnosing thoracic outlet syndrome.Hand Clin. 2004; : 27-36
- Evaluation of MR angiographic technique in the assessment of thoracic outlet syndrome.Clin Radiol. 2004; 59: 588-595
- Contrast-enhanced three-dimensional MR angiography in the assessment of subclavian artery diseases.Eur Radiol. 2000; 10: 1737-1744
- Thoracic outlet syndrome with subclavian aneurysm in a very young child: the complementary value of MRA and 3D-CT in diagnosis.Pediatr Radiol. 2002; 32: 22-24
- Diagnosis of vascular compression at the thoracic outlet using magnetic resonance angiography.Eur Neurol. 2004; 51: 122-123
- Diagnosis of vascular compression at the thoracic outlet using gadolinium-enhanced high-resolution ultrafast MR angiography in abduction and adduction.Cardiovasc Intervent Radiol. 2000; 23: 152-154
- Thoracic outlet syndrome: provocative maneuvers in a typical population.J Shoulder Elbow Surg. 1995; 4: 113-117
- The false-positive rate of thoracic outlet syndrome shoulder maneuvers in healthy subjects.Acad Emerg Med. 1998; 5: 337-342
- Thoracic Outlet Syndrome, A Common Sequela of Neck Injuries.J.B. Lippincott Company, Philadelphia1991
- Arterial thoracic outlet syndrome.Hand Clin. 2004; 20: 107-111
- Thoracic outlet syndrome.Neurosurgery. 2004; 55: 897-903
- Thoracic Outlet Syndrome.Futura Publishing Co., Inc., Mount Kisco, NY1986
- Thoracic outlet syndrome: does fiction outweigh facts?.Curr Opin Orthop. 2003; 14: 209-214
- A comparative study of structures comprising the thoracic outlet in 250 human cadavers and 72 surgical cases of thoracic outlet syndrome.Eur J Cardiothorac Surg. 1998; 13: 353-360
- Anomalies at the thoracic outlet are frequent in the general population.Am J Surg. 1995; 170: 33-37
- Anatomical variations of the scalene triangle: dissection of 10 cadavers.J Orthop Sports Phys Ther. 2001; 31: 70-80
- The subclavius posticus muscle: a factor in arterial, venous or brachial plexus compression?.Surg Radiol Anat. 2000; 22: 111-115
- Magnetic resonance neurography of peripheral nerve following experimental crush injury, and correlation with functional deficit.J Neurosurg. 2002; 96: 755-759
- Clinical Magnetic Resonance Angiography.Raven Press, New York1993
- Basic principles of MRA.Eur J Radiol. 2001; 38: 2-9
- Three-dimensional gadolinium-enhanced magnetic resonance venography is suspected thrombo-occlusive disease of the central chest veins.Chest. 2001; 120: 1570-1576
- Safety of gadolinium contrast angiography in patients with chronic renal insufficiency.J Vasc Surg. 2003; 38: 313-318
- Magnetic Resonance Angiography A Practical Approach.McGraw-Hill, New York, NY1995
- Thoracic outlet: assessment with MR imaging in asymptomatic and symptomatic populations.Radiology. 2003; 227: 461-468
- Evidence-Based Medicine.2nd ed. Churchill Livingstone, Philadelphia2000
JHT Read for Credit
Quiz: Article #043
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. There is only one best answer for each question.
- #1.The incidence of TOS seems to be:
- a.unknown.
- b.unchanged.
- c.decreasing.
- d.increasing.
- a.
- #2.The purpose of the article was to examine the literature supporting evidence for the use of
- a.MRA in diagnosing all forms of TOS.
- b.MRA in treating all forms of TOS.
- c.MRA in diagnosing arterial type TOS.
- d.MRA in treating arterial type TOS
- a.
- #3.Which type of TOS is most prevalent?
- a.neurogenic
- b.disputed neurogenic
- c.arterial
- d.venous
- a.
- #4.In cadaveric studies, researchers found what incidence of TOS type anomalies? A range of about:
- a.50–75%
- b.35–45%
- c.0–25%
- d.75–95%
- a.
- #5.The article suggests that the evidence for diagnosing arterial TOS with MRA is
- a.convincing.
- b.not compelling.
- a.
When submitting to the HTCC for recertification, please batch your JHT RFC certificates in groups of three or more to get full credit.
Article info
Identification
Copyright
© 2006 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.