Practice
A Patient’s Journey
Thoracic outlet syndrome
Cite this as:
BMJ
2012;345:e7373
Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on bmj.com. Although a selection of rapid responses will be included as edited readers' letters in the weekly print issue of the BMJ, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window.
Displaying 1-2 out of 2 published
The airway dictates much of head posture and hierarchically takes precedence. Check SCMs and Scalenes before and after placing 1, 2 or 3 tongue blades between the molars.
you will also see the head 'correct' its position when the lower jaw shifts (use the "S" sound to locate ideal position.)
also common is 'whiplash type injury that never seems to fully heal (prolotherapy can help there). when head goes forwards, airway improves, but at the expense of Scalenes, SCMs and others finally the Trapezius.
This is the genesis of Tension Type Headaches and many can be reversed with 2 bits of wood!
there is a significant body of EMG and similar work now to link Temporalis and other muscles to such activity. this is seen dentally in questionable approach to orthodontic crowding by removal of teeth. sure it solves the dental issue, but adds to oropharyngeal constriction. Look at the lateral tongue border, 70% of those with Scalloped Borders will have Obstructive Sleep Apnoea and 34% of the female cohort will develop PCOS.
there are many such links that are more recently being established.
DZ
Competing interests: None declared
Private Practise, Vipond Road Stanmore Bay Whangaparaoa New Zealand
Dr. Giele,
You mention that TOS can result from a variety of structural deviations that are not usually identifiable on MRI. Can TOS result from hypertonic soft tissue (e.g. the scalenes or pectoralis minor) impinging on neurovascular structures? And, if so, given equivocal MRI findings might it be best to first treat a patient with TOS conservatively (e.g. prescription for massage therapy of the accessory breathing muscles) before considering the more invasive option of surgery?
Thank you for your time and I look forward to your response.
Best,
Marco Masci
Competing interests: None declared
Weill-Cornell Medical College, 445 E. 69th St, #804, NYC, NY 10021 USA
Re: Better management of patients with multimorbidity
Published 17 May 2013
Re: India must raise the status of primary care
Published 17 May 2013
Re: Partnering with patients
Published 17 May 2013
Re: Rescue boards are set up in England to deal with “significant deterioration” in A&E departments
Published 17 May 2013