Thoracic Outlet Syndrome (TOS) Information

Time 2020-10-25 03:02:28

Web Name: Thoracic Outlet Syndrome (TOS) Information

WebSite: http://www.tosinfo.com

ID:93362

Keywords:

Outlet,Thoracic,Syndrome,

Description:

2D Time of Flight MRA / MRV displaying the decreased proton density of costoclavicular compression of the subclavian veins accentuating the proximally dilated high proton dense right axilary vein as compared to the left, and the proximal high proton dense right facial vein Migraine, carpal tunnel syndrome, reflex sympathetic dystrophy (RSD) syndrome, dystonia, fibromyalgia, impingement, piriformis syndrome, and thoracic outlet syndrome are clinical diagnoses because what is common to all is a decrease in blood flow. They are not pathological ( fascial plane alteration ) diseases. The pathological cause is based upon the decrease in blood flow. The radiologist must know landmark anatomy to make an accurate diagnosis. You only see what you know! The terms neurogenic and neurovascular are misconceptions. They are clinical terms. Nerves DO have a blood supply! (arteries, veins, and lymphatics)1 Image the artery and you image the nerve that binds to the artery for its nutrient blood supply. Research shows, compressing a nerve also compresses the blood supply. Laxity of the sling/erector muscles of the shoulder girdle causes costoclavicular compression2. Costoclavicular compression is compression of the bicuspid valves within the draining veins of the neck, supraclavicular fossa with lymphatics, that diminishes the blood supply to and from the brachial plexus and the rest of the circulatory system. If costoclavicular compression is not corrected, ischemia with degenerative changes and fibrosis develops, not limited to the brachial plexus, but also involving the brain (i.e. short term memory loss). Any decrease in venous return diverts venous and lymphatic flow back into the vertebral venous plexus / Batson's plexus that expands the spinal canal and soft tissues that increases intrathoracic, intracranial, and intraabdominal pressure that triggers TOS complaints as displayed on MRI/MRA/MRV3,4.Batson's venous plexus, an extensive paravertebral system ofvalve-less venous channels within and alongside the spinal canal,provides direct venous communication from the peritoneum andlower body to the cranial cavity and spinal canal. Obstructed venousreturn increases intracranial, intrathoracic, and intra-abdominalpressure. In migraine and TOS patients bicuspid valve compression(costoclavicular) within the veins of the neck and supraclavicularfossae, and neurovascular bundles causes collateral venous return,expands fascial planes, and triggers complaints of upper extremitynumbness and tingling; pain; temperature and color changes; visual blurring and floaters; and headache. Obstruction to venousreturn causes dilatation of Batson's plexus. Lesser recognized symptoms of TOS venous obstruction are neck pain, pain in the hip,groin, and low back, with radicular pain in the leg and feet, reflecting the proximity of the dilated plexus to the disks and spinal nerveroots. Abduction external rotation enhances TOS symptoms and migraine.10 Patients with the clinical diagnosis of migraine (TOS) present with upper extremity pain and paresthesias; migrainous headache with or without visual changes (floaters and/or blurred vision); tinnitus; facial, back, chest and leg pain4; muscle spasms and dystonia, syncope, hypertension, and upper extremity lymphedema5. Some patients present with chronic, debilitating gastrointestinal complaints beyond the nausea and vomiting of the migraine attack and in addition to the usual TOS symptoms6. Tinnitus, by definition, is a latin word meaning "ringing" in the ears. Tinnitus in patients with TOS and/or costoclavicular compression is the result of compression of the inferior bicuspid valve of the internal jugular vein. This results in turbulence of the venous return, like pouring water in a glass. The blood backs up into the sigmoid sinus adjacent to the tympanic membrane of the ear that the patient interprets as a low-pitched sound and/or ringing in the ear - that has been described as a swooshing sound. The sounds may be triggered by just placing a turniquet, blood pressure cuff, and/or hands around the upper arm obstructing venous return that triggers complaints in patients with TOS6. Thoracic Outlet Syndrome patients display forward rotated shoulders that increases the slope of the first ribs, backwardly displacing the manubrium, posterior right and/or left that crimps the great vessels (like a water hose)7. Crimping diminishes nutrient arterial, venous, and lymphatic circulation to the five senses (hearing, sight, smell, taste, touch) that triggers patient's complaints. The most common causes of missed diagnosis of Thoracic Outlet Syndrome (TOS) Nerves do have a blood supply1 Confounding overlapping symtoms associated with degenerative disc disease Non recognition of the clinical symptoms of TOS (especially in children and teenagers)8 Lack of routine chest radiographs to rule out osseous and soft tissue landmark abnormalities9 Absence of monitored MRI imaging of landmark anatomy (brachial plexus, head and neck, thorax) Surgery performed without monitored MRI imaging Non recognition of the enlargement of the thyroid gland compressing the inferior bicuspid valve within the internal jugular veins Non recognition of the increased slope of the first ribs backwardly displacing the manubrium crimping (like a water hose) the great vessels Lack of recorded blood pressure measurements by the physician and the omission of the Adson's maneuver during the physical examination Obstruction of venous return triggers complaints of vertebral venous plexus/batson's plexus radiculopathy/radicular pain10,11 Ultrasound should not be used as a diagnostic evaluation for Thoracic Outlet Syndrome. Ultrasound does not display landmark anatomy, fibrosis, and full field of view for other anomaliesYour browser does not support the video tag.Beating Heart (coronal) displaying the in-phase blood supply (arterial and venous), neck, shoulders, chest wall, and abdomenYour browser does not support the video tag.Beating Heart (inverted) displaying a different perspective from the above coronal video as the blood changes from white to black(0:26)Your browser does not support the video tag.Beating Heart (sagittal) observe the coronary arteries, azygos and brachiocephalic veins, thyroid, and vertebral venous plexus/Batson's plexus of the vertebral column Dr. James D. Collins monitors bilateral MRI, MRA, MRV of the brachial plexus at the imaging console without contrast injections and displays landmark anatomy according to grayscale proton density. The grayscale digital images reflect the concentration of proton density or high signal intensity. Generally, a gray scale will show fat as a white (high signal) image, muscle as shades of gray, and decreasing blood flow also in shades of gray. Because excited protonsare best imaged in the static state, the flowing state renders a dark or black signal because the excited protonshave moved on and are not available for imaging. Therefore, blood is white (high signal) in the static stateand black (low signal) in the flowing state. PA and lateral chest and AP cervical thoracic spine radiographs are acquired prior to the brachial plexus imaging. The functional anatomic series, abduction external rotation (AER) of the upper extremities is the last imaging sequence acquired enhancing sites of costoclavicular compression that triggers patients' complaints. Annotation of the images is the key to understanding the anatomy.Dr. Collins's Thoracic Outlet Syndrome (TOS) ABSTRACTS for publicationYour browser does not support the video tag.Dr. Collins in the MRI Suite and at the MRI Consultation Console This is one of many legal landmark cases of Thoracic Outlet Syndrome where the use of bilateral MRI/MRA/MRV brachial plexus imaging displayed one of the anatomic causes of TOS. Leslie S. Caplan and Federal Judiciary US District Court. Her benefits were reinstated. Another patient, Simon Lewis, who was successfully diagnosed and treated for Thoracic Outlet Syndrome has taken it one step further and has used the bilateral MRI/MRA/MRV imaging and diagnostic findings to write a book about his recovery from a near fatal accident. His book is entitled Rise and Shine and the book's website is filled with many nice images and illustrations.Website: riseandshinethebook.com This is a 5-FT tall female FBI agent injured during required firearms training. Her worker's compensation case was finally accepted following bilateral MRI/MRA/MRV of the brachial plexus. Here is her personal testimonial regarding the settlement of her FBI Worker's Compensation Case and the long road it took to get there. Upcoming Presentations with Dr. CollinsFASEBExperimental Biology (EB)April 22 - 26, 2017(APS, ASBMB, ASPET, ASIP, ASN, AAA)Chicago, IL43rd Annual UCLA Family Medicine Refresher CourseMarina Del Rey MarriottMarina Del Rey, CAMarch 2017American Association of Clinical AnatomistsJuly 17-21, 2017Minneapolis, MNNational Medical Association Annual Convention & Scientific AssemblyJuly 29 - August 2, 2017Pennsylvania Convention CenterPhiladelphia, PennsylvaniaJames D. Collins, M.D. is a full-time Professor and General Radiologist in the UCLA Department of Radiological Sciences. He specializes in bilateral 3D MRI/MRA imaging of the brachial plexus, and has been performing these studies since 1985. The bilateral 3D MRI/MRA has provided anatomic evidence of thoracic outlet syndrome (compression of the bicuspid valves within the internal jugular and subclavian veins) for neurological evaluation and corrective physical therapy and surgery. The entire procedure is monitored by Dr. Collins at the workstation. After the MRI/MRA/MRV imaging is complete, Dr. Collins spends a great deal of time annotating images and explaining his findings to his patients. He is a favorite of patients, past and present.Dr. Collins has published extensively in journals such as Clinical Anatomy and Family Practice Recertification. He is a member of many professional societies, including the American Association of Clinical Anatomists (AACA), the British Association of Clinical Anatomists (BACA), the American Association of Anatomists (AAA), the Radiological Society of North America (RSNA), the California Radiological Society (CRS), the Los Angeles Radiological Society (LARS), the Radiology Section of the National Medical Association (NMA), and the Alpha Omega Alpha (AOA) Honor Medical Society. Dr. Collins is currently the radiology editor for the Journal of National Medical Association and Radiology Rounds Section Editor for the Family Practice Recertification.Brachial plexus and lymphangiograms with Dr. Collins may be scheduled through the UCLA Radiology scheduling department at 310.301.6823.Comments or suggestions? Contact the webmaster at stevedo@gmail.com.High resolution imaging and videos courtesy of ucla radiology media center.Acknowledgements to David Nelson and Steven Do @ucla radiology media center.[Last update: Thursday, June 14th, 2018]

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Thoracic outlet syndrome (TOS) information. Features video download and image gallery from 3D MRI/MRA/MRV by James Collins, MD at UCLA.

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