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LETTERS: Nicola A Cooper Dizziness is not diagnostic BMJ 2007; 334: 600-b [Full text]

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A neglected cause of dizziness and neck pain

Carlos A Selmonosky   (25 March 2007)

A neglected cause of dizziness and neck pain 25 March 2007
Carlos A Selmonosky, Physician Arlington Free Clinic.VA.USA Send response to journal: Re: A neglected cause of dizziness and neck pain	Thoracic Outlet Syndrome(TOS) causes dizziness because of positional compression of the vertebral artery with resultant symptoms of vertebrobasilary insufficiency. Compression of C7,C8,and T1 nerves fibers is responsible for the neck pain. The diagnosis of TOS should be performed in all patients complaining of dizziness and or neck pain; because TOS may be partially or totally responsible for the symptoms attributed to another pathology. The clinical diagnosis of TOS is made by the use of a Diagnostic Triad in the physical examination: 1) weakness of abduction and adduction of the fifth finger(C8, T1). 2) Tireness,paresthesias of the upper extremity on elevation of the hands pointing to the ceiling. Associated or not with paleness of the hands; extreme paleness is called the White Hand Sign. 3) tenderness on thumb pressure in the supraclvicular area.(See www.tos-syndrome.com). The cervical spine Xrays reports should include the anomalies of the transverse process of the 7th cervical vertebra: elongation, enlargement, downwards beaking; because they are commonly present in patients with TOS who had a positive triad. In the cervical spine radiological picture shown in the paper there is a elongated transverse process of the 7th cervical vertebra seen. References 1. Bacquey F,Hamon M,Coskum O.Rotational vertebro-basilary insufficiency secondary to a fibrous band of the longus coli muscle:Value of CT spiral angiography diagnosis.J Radiol.2002;83:979-982. 2. Sell J J,Rael J R,Orrison W W.Rotational vertebrobasilary insufficiency as a component of thoracic outlet syndrome resulting in transient blindness. Case report.J Neurosurg.1994 Oct;81(14):617-619. 3. Dadsetan M R,Skerhut H E.Rotational vertebrobasilary insufficiency secondary to vertebral artery occlusion from fibrous band of the longus coli muscle.Neuroradiology.1990; 32:514-515. 4. Demos N J.Rubenstein H.Restivo C S.Role of scalenotomy for relief of positional vertebrobasilary ischemia.J Med Soc N J.1980;77:419-422. 5. Hardin C A,Poser C M.Rotational obstruction of the vertebral artery due to redundancy and extra luminal cervical fascial bands.Ann Surg.1963;158:133-137. 6. Powers S R,Drislaine T M,Nevins s.Intermittent vertebral artery compression;a new syndrome.Surgery. 1961;49:257-264. 7. Selmonosky C A.The white hand sign.A new simple maneuver useful in the diagnosis of thoracic outlet syndrome.(Abstract)South Med J.2002 Oct;85(10):S.57 8. Schenardi C.Whiplash injury.TOS and double crush syndrome.Forensic medical aspects.Acta Neurochir Supp 2005;92:25-7 Competing interests: None declared