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神経性胸郭出口症候群は,上肢・指のしびれがほぼ必発で,他覚的な神経症候に乏しく,各種誘発試験が診断に有用であると従来考えられていた。しかし,そのうち,真の神経性胸郭出口症候群(TN-TOS)のみが,下部腕神経叢が下方から圧迫されて生じる明確な疾患であることがわかってきた。TN-TOSではT1>C8支配筋の筋力低下・筋萎縮が必発かつ前景に立っており,感覚障害は前腕内側を中心に認められることが多いが一般に軽度である。
Abstract
Thoracic outlet syndrome (TOS) is a well-known disorder, but many aspects of its pathology, including its definition, has been disputed. True neurogenic TOS (TN-TOS) is a rare but well-defined clinical condition. TN-TOS results from the compression of the C8/T1 roots (dominant for the T1 root) or the proximal lower trunk of the brachial plexus by a fibrous band. The band extends from the first rib to either the tip of an elongated C7 transverse process or a rudimentary cervical rib. The most common presenting symptoms of TN-TOS are insidious-onset atrophy and weakness of the intrinsic hand muscles, predominantly in the thenar eminence and radial digit flexors. Nerve conduction studies demonstrate pathognomonic findings: severely attenuated compound muscle action potential of the abductor pollicis brevis muscle, and usually, loss of the sensory nerve action potential of the medial antebrachial cutaneous nerve. Numbness and sensory loss are typically observed, mainly in the medial forearm, although they are usually mild, and may be absent in some patients. Severe pain or paresthesia proximal to the elbow is not observed. The classical concept of TOS underlie nonspecific neurogenic TOS. It has been primarily diagnosed using provocative maneuvers. However, there is controversy regarding its pathological conceptualization and existence, as objective evidence of the disease is still lacking.
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