Vascular compression in the thoracic outlet. Age dependent normative values in noninvasive testing

Area of Science:

• Vascular Surgery
• Neurology
• Diagnostic Imaging

Background:

• Thoracic outlet syndromes involve vascular or nerve compression.
• Accurate diagnosis necessitates thorough clinical examination and objective testing.
• Understanding normal vascular responses to provocative maneuvers is crucial.

Purpose of the Study:

• To determine the frequency of vascular compression in normal subjects across different age groups.
• To establish baseline data for interpreting provocative thoracic outlet compression maneuvers.
• To differentiate normal vascular responses from pathological findings.

Main Methods:

• Recruitment of normal volunteers aged 15-85, stratified into 5-year age groups.
• Utilized plethysmography to measure digital pulse changes during three thoracic outlet compression maneuvers.
• Assessed vascular pulsation changes during 120 degrees arm abduction, Adson maneuver, and military attitude in supine position.

Main Results:

• Vascular compression to zero flow during 120 degrees arm abduction was observed frequently in normal subjects, indicating it is a normal finding.
• Zero flow during Adson maneuver and military attitude in the supine position was infrequent in normal individuals.
• No significant differences in findings were noted across different age groups or sexes.

Conclusions:

• Establishing zero flow via costoclavicular or scalenic compression maneuvers is clinically significant for diagnosing thoracic outlet syndrome.
• Zero flow during 120 degrees arm abduction (pectoralis minor compression) is within normal physiological limits and not indicative of pathology.
• These findings aid in the accurate interpretation of objective testing for thoracic outlet syndrome.