Utilisation de l' échographie dans le syndrome du défilé thoraco brachial dû au muscle mineur du pectoral dystonique .
Ib R. Odderson, DM, PhD, Edouard S. Chun, DM, Orphée Kolokythas, DM et R. Eugene Zierler, DM Départements de la médecine de réadaptation (I.R.O.) et la radiologie (CORRECTE) et la Division de la chirurgie vasculaire (R.E.Z.), université de centre médical de Washington, Seattle, Washington Etats-Unis ; et centre médical d'hôpital d'Overlake, Bellevue, Washington Etats-Unis (E.S.C.).
Adressez la correspondance à Ib R. Odderson, DM, PhD, département de la médecine de réadaptation, université de Washington, la boîte 356490, 1959 rues Pacifiques de Ne, Seattle, WA 98195 Etats-Unis.
Email : odderson@u.washington.edu
Objectif
Pour des patients présentant un SDTB, il est important de déterminer l'endroit de la compression neurovasculaire pour réaliser une intervention efficace.
Méthodes
La manoeuvre diagnostique pour un homme de 39 ans avec un SDTB a inclus un bloc anesthésique sélectif du au muscle mineur pectoral et de l'échographie duplex avant et après le bloc.
Résultats
La vitesse d'écoulement systolique de crête d'artère subclaviaire a diminué après le bloc de 208 à 63 cm/s quand le bras était en position d'abduction et de rotation d'external, indiquant une réduction de la sévérité de la compression artérielle focale.
En outre, le diamètre artériel a augmenté de 10% après le bloc (de 0.80 à 0.88 cm).
Son niveau de malaise a été réduit de 6 à 2 sur une échelle de 1 à 10 (66%).
Conclusions
Le bloc du muscle mineur pectoral a eu comme conséquence une amélioration de flux de sang et de symptômes d'artère subclavian et a confirmé le diagnostic du SDTB du muscle mineur pectoral.
Ceci suggère que les blocs anesthésiques sélectifs du muscle et les études échographiques duplex puissent être utiles avant chemodenervation et chirurgie.
ARTICLE
by the American Institute of Ultrasound in Medicine
Technical Advance
Use of Sonography in Thoracic Outlet Syndrome Due to a Dystonic Pectoralis Minor
Ib R. Odderson, MD, PhD, Edward S. Chun, MD, Orpheus Kolokythas, MD and R. Eugene Zierler, MD
Departments of Rehabilitation Medicine (I.R.O.) and Radiology (O.K.) and Division of Vascular Surgery (R.E.Z.), University of Washington Medical Center, Seattle, Washington USA; and Overlake Hospital Medical Center, Bellevue, Washington USA (E.S.C.).
Address correspondence to Ib R. Odderson, MD, PhD, Department of Rehabilitation Medicine, University of Washington, Box 356490, 1959 NE Pacific St, Seattle, WA 98195 USA. E-mail: odderson@u.washington.edu
Objective. For patients with thoracic outlet syndrome (TOS), it is important to determine the location of the neurovascular compression to achieve effective intervention. Methods. The diagnostic workup for a 39-year-old man with TOS included a selective anesthetic block of the pectoralis minor muscle and duplex sonography before and after the block. Results. The subclavian artery peak systolic flow velocity decreased after the block from 208 to 63 cm/s when the arm was in the abduction and external rotation position, indicating a reduction in the severity of focal arterial compression. Also, the arterial diameter increased by 10% after the block (from 0.80 to 0.88 cm). His level of discomfort was reduced from 6 to 2 on a scale of 1 to 10 (66%). Conclusions. The pectoralis minor block resulted in an improvement in subclavian artery blood flow and symptoms and confirmed the diagnosis of pectoralis minor TOS. This suggests that selective anesthetic muscle blocks and duplex sonographic studies may be useful before chemodenervation and surgery.
Key Words: dystonia • electrodiagnostic studies • pectoralis minor • subclavian artery blood flow • thoracic outlet syndrome
Abbreviations: AER, abduction and external rotation • EMG, electromyography • PSV, peak systolic velocity • TOS, thoracic outlet syndrome
Use of Sonography in Thoracic Outlet Syndrome Due to a Dystonic Pectoralis Minor
Ib R. Odderson, MD, PhD, Edward S. Chun, MD, Orpheus Kolokythas, MD and R. Eugene Zierler, MD
Departments of Rehabilitation Medicine (I.R.O.) and Radiology (O.K.) and Division of Vascular Surgery (R.E.Z.), University of Washington Medical Center, Seattle, Washington USA; and Overlake Hospital Medical Center, Bellevue, Washington USA (E.S.C.).
Address correspondence to Ib R. Odderson, MD, PhD, Department of Rehabilitation Medicine, University of Washington, Box 356490, 1959 NE Pacific St, Seattle, WA 98195 USA. E-mail: odderson@u.washington.edu
Objective. For patients with thoracic outlet syndrome (TOS), it is important to determine the location of the neurovascular compression to achieve effective intervention. Methods. The diagnostic workup for a 39-year-old man with TOS included a selective anesthetic block of the pectoralis minor muscle and duplex sonography before and after the block. Results. The subclavian artery peak systolic flow velocity decreased after the block from 208 to 63 cm/s when the arm was in the abduction and external rotation position, indicating a reduction in the severity of focal arterial compression. Also, the arterial diameter increased by 10% after the block (from 0.80 to 0.88 cm). His level of discomfort was reduced from 6 to 2 on a scale of 1 to 10 (66%). Conclusions. The pectoralis minor block resulted in an improvement in subclavian artery blood flow and symptoms and confirmed the diagnosis of pectoralis minor TOS. This suggests that selective anesthetic muscle blocks and duplex sonographic studies may be useful before chemodenervation and surgery.
Key Words: dystonia • electrodiagnostic studies • pectoralis minor • subclavian artery blood flow • thoracic outlet syndrome
Abbreviations: AER, abduction and external rotation • EMG, electromyography • PSV, peak systolic velocity • TOS, thoracic outlet syndrome
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