Professional Med J 2018;25(3):350-354. www.theprofesional.com THORACIC OUTLET SYNDROME 350 The Professional Medical Journal www.theprofesional.com THORACIC OUTLET SYNDROME; MANAGEMENT AND DIAGNOSIS OF PATIENTS–TRUE PICTURE ORIGINAL PROF-4386 Khadija Iqbal 1 , Aisha Asim 2 , Ibad-ur-Rehman 3 , Samra Asif 4 ABSTRACT... Introduction: Thoracic outlet syndrome represents a variety of symptoms ranging from neurogenic to vascular. The thoracic outlet syndrome considered as a disputed disorder and management and diagnosis need special attention. Objective: The present study was done with the objective was to observe association of thoracic outlet syndrome with cervical rib and the treatment and diagnosis options given to the patients once they present in the OPD. Study Design: Observational. Sampling: Convenience. Duration: January 2015-2017 January. Materials and methods: In this study the cervical rib was present in 3 males out of 58 cases. In females 8 had cervical rib out of 150 cases. Results: Out of eleven patients only six were advised surgical excision to relieve symptoms of thoracic outlet syndrome. Analgesics were also prescribed to all patients. The second category who did not have cervical rib nerve conduction studies were advised to only 12 males and 10 females. In our study patients presenting with numbness or and any vascular complaint only 11 cases had cervical rib. The treatment advised for relieving symptoms was surgical in only six patients and analgesics in all cases. The treatment for patients without cervical rib was analgesics and nerve conduction was advised only in 22 patients. Conclusion: The diagnosis and management of TOS is a combination of neurophysiological testing and clinical examination outcomes. The use of advanced techniques can lead to better patient management in our hospitals. Key words: Thoracic outlet syndrome, cervical rib, anaegesics, numbness, nerve conduction 1. M.B.B.S, FCPS (Anatomy) Professor Anatomy Al Nafees Medical College Isra University. 2. FCPS Diagnostic Radiology Assistant Professor Department of Radiology Al Nafees Medical College Isra University. 3. Second Year M.B.B.S Student Shifa College of Medicine Islamabad. 4. 4 th Year B.D.S Student Margalla Institute of Health Sciences UHS Lahore. Correspondence Address: Dr. Khadija Iqbal P1024 Asghar Mall Road, Rawalpindi. Khadijaiqbal1972@gmail.com Article received on: 05/10/2017 Accepted for publication: 30/12/2017 Received after proof reading: 28/02/2018 Article Citation: Iqbal K, Asim A, Ibad-ur-Rehman, Asif S. Thoracic outlet syndrome; management and diagnosis of patients–true picture. Professional Med J 2018;25(3):350-354. DOI:10.29309/TPMJ/18.4386 INTRODUCTION Thoracic outlet syndrome represents a variety of symptoms ranging from neurogenic to vascular. 1 Compression of neurovascular structures in interscalene triangle is the most known cause but it is a disputed defnition and venous causes are also included now. 2 Diagnosing and managing TOS can be challenging because the symptoms vary greatly amongst patients with the disorder. 3 Many studies show a dispute in diagnosis of the syndrome as whether the predominant type is neurogenic or vascular. Also the referral of the patients to the neurosurgeon, general surgeons or medical specialist is still controversial. 4,5 In Pakistan this syndrome is increasing. Mostly women present with complaints and the syndrome is also common in females in western population. 6 Most women present with numbness in upper limb or with pain n hand muscles. 7 Some may present with neck pain. These sympto 12 ms become worse on doing physical activities. 8 Some may complain of pain radiating in the submandibular region and heaviness in the shoulder region. 9 The commonest cause associated with thoracic outlet syndrome in our country is cervical rib. Cervical rib is a common congenital condition. 10 A cervical rib usually takes origin from the anterior tubercle of the transverse process of the seventh cervical vertebra. It may have a free anterior end, may be connected to the frst rib by a fbrous band, or may articulate with the frst rib. There are several presentations of the cervical rib. 11 It can be a foating rib, connected to frst rib through a fbrous tissue or it may form a joint with frst rib.It is most commonly on the right side but can be present on the left side. Sometimes it occurs bilaterally. It remains unnoticed in some individuals butit can DOI: 10.29309/TPMJ/18.4386