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Related Experiment Videos

Post-traumatic thoracic outlet syndrome (TOS).

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
Summary

Thoracic Outlet Syndrome (TOS) can arise from trauma, causing nerve compression due to soft tissue changes. The pain-immobility-fibrosis loop is crucial in developing this condition after injury.

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TOS pathophysiology and clinical features.

Acta neurochirurgica. Supplement·2005

Area of Science:

  • Neurology
  • Traumatology
  • Pathology

Background:

  • Thoracic Outlet Syndrome (TOS) is typically a non-tumorous compressive syndrome of the brachial plexus.
  • Trauma can lead to irritative and lesional plexus syndromes, where nerve compression results from long-lasting pathological changes post-injury.
  • Whiplash-type injuries, involving head acceleration-extension, stretch cervical soft tissues, potentially initiating TOS development.

Purpose of the Study:

  • To explore the potential of trauma-induced pathological changes to cause Thoracic Outlet Syndrome.
  • To elucidate the mechanism by which whiplash injuries may lead to brachial plexus syndromes.
  • To highlight the role of the pain-immobility-fibrosis loop in the pathogenesis of TOS following trauma.

Main Methods:

  • Review of mechanisms involved in whiplash injuries and their effect on cervical soft tissues.

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  • Analysis of the sequence of events during head acceleration-extension, including temporomandibular joint (TMJ) dynamics.
  • Pathophysiological examination of connective tissue changes, fibrosis, and the development of microadhesences.

    • Main Results:

    • Head acceleration-extension in traffic accidents causes significant stretching of cervical soft tissues.
    • Lack of headrest support exacerbates soft tissue stretching, potentially leading to paraneurial fibrosis.
    • Prolonged antalgic contracture and motor neglect contribute to a cycle of pain, immobility, and fibrosis.

    Conclusions:

    • Trauma, particularly whiplash, can initiate a cascade of events leading to Thoracic Outlet Syndrome.
    • The development of fibrosis in the paraneurium, driven by the pain-immobility-fibrosis loop, is a key outcome.
    • Understanding these mechanisms is vital for diagnosing and managing TOS in trauma patients.