Alphonsus Chong's Personal Wiki

William H. Pearce Precourse Notes https://www.assh.org/videos/precourse-5-surgical-management-of-thoracic-outlet-syndrome-38172?fs=true

shoulder - tripod on thorax

abnormal bony structure vs normal structure in abnormal position

* splinter hemorrhages * arm claudication vs “fatigue” * digital gangrene/pain * raynaud's phenomenon - digital/ unilateral hand * neurogenic symptoms (30%) - true vs disputed * pulsatile neck mass

* history: overuse/ direct trauma * physical

1. position of use
2. arterial exam

* need good imaging in correct position

3rd part of subclavian or axillary - pect minor/ humeral head posterior circumflex humeral artery

need proper angiogram in position of use

- decompression - remove aneurysm - reconstruction - peripheral emboli

Cervical rib bony parts, fibrous, clavicular fractures

Ix: 3D recon with CTA

Access - supra and infra-clavicular incisions

Normal structures in abnormal positions - first rib/ clavicle - scalene? - humeral head - quadrilateral space

Humeral head problems - mobilization - patch - interposition - bypass

Quadrilateral space problem - between teres minor/ major/ two heads of triceps

- unusual problems - flexible surgical approach - non-medical issues

febe - shoulder - pect major nerve release - ? triceps tight - finger release

https://wiki.nus.edu.sg/display/HS/Thoracic+Outlet+Syndrome