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TOS pathophysiology and clinical features.

F M Crotti1, A Carai, M Carai

  • 1Clinica Neurochirurgica dell'Università di Sassari, Sassari, Italy. franc.crotti@tiscali.it

Acta Neurochirurgica. Supplement
|April 16, 2005
PubMed
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Thoracic outlet syndrome (TOS) surgery effectively resolves neurological and vascular pain. However, myofascial pain persists, suggesting a separate pain loop not fully addressed by surgical intervention alone.

Area of Science:

  • Orthopedics
  • Neurology
  • Pain Medicine

Background:

  • Thoracic outlet syndrome (TOS) presents with neurological, vascular, and myofascial pain.
  • Two patient groups emerged: one with anatomical variants causing nerve compression, the other with postural deviations and brachial plexus adhesions causing nerve distraction.

Purpose of the Study:

  • To differentiate TOS subtypes based on etiology and surgical outcomes.
  • To investigate the role of myofascial pain in TOS and its response to surgical treatment.

Main Methods:

  • Analysis of 280 patients operated on for TOS.
  • Categorization of patients based on anatomical findings versus postural deviations.
  • Assessment of pre- and post-operative neurological, vascular, and myofascial pain symptoms.

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Main Results:

  • Surgical intervention resolved neurological and vascular pain in all TOS patients.
  • Myofascial pain persisted post-surgery, particularly in patients with postural deviations and brachial plexus adhesions.
  • A pain-immobility-fibrosis loop, potentially linked to myofascial hemisyndrome, was identified as a key factor in persistent pain.

Conclusions:

  • TOS surgery is effective for neurovascular symptoms but not for associated myofascial pain.
  • Myofascial pain in TOS may stem from a distinct pathogenetic mechanism (e.g., myofascial hemisyndrome) not solely dependent on TOS.
  • A multimodal approach addressing both TOS and myofascial pain components is crucial for comprehensive patient management.