{"id":2782,"date":"2024-11-20T23:48:15","date_gmt":"2024-11-20T23:48:15","guid":{"rendered":"https:\/\/kamranaghayev.com\/torasik-outlet-sendromu-teshisi\/"},"modified":"2025-05-11T12:46:17","modified_gmt":"2025-05-11T12:46:17","slug":"torasik-outlet-sendromu-teshisi","status":"publish","type":"post","link":"https:\/\/kamranaghayev.com\/tr\/torasik-outlet-sendromu-teshisi\/","title":{"rendered":"Torasik Outlet Sendromu Tan\u0131s\u0131"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\" id=\"h-how-do-we-diagnose-tos\">TOS&#8217;u nas\u0131l te\u015fhis ederiz?<\/h2>\n\n<p class=\"\">Torasik \u00e7\u0131k\u0131\u015f sendromunun te\u015fhisi zordur \u00e7\u00fcnk\u00fc tam g\u00fcvenilecek bir do\u011frulay\u0131c\u0131 tan\u0131 y\u00f6ntemi yoktur. Te\u015fhisin en \u00f6nemli k\u0131sm\u0131, TOS hastal\u011f\u0131ndan \u015f\u00fcphelenmektir. Deneyimli doktorlar bile TOS&#8217;un belirti ve semptomlar\u0131n fark\u0131nda olmayabilir. \u00d6rne\u011fin, Amerika Birle\u015fik Devletleri&#8217;nde yap\u0131lan bir ara\u015ft\u0131rma, hastalar\u0131n do\u011fru te\u015fhis almadan \u00f6nce ortalama d\u00f6rt doktor ziyaret etti\u011fini ortaya koymu\u015ftur. <sup><a href=\"#footnote_1_2782\" id=\"identifier_1_2782\" class=\"footnote-link footnote-identifier-link\" title=\"Landry GJ, Moneta GL, Taylor LM, Jr., Edwards JM, Porter JM. Long-term functional outcome of neurogenic thoracic outlet syndrome in surgically and conservatively treated patients. J Vasc Surg. 2001;33(2):312-317; discussion 317-319. https:\/\/doi.org\/10.1067\/mva.2001.112950\">1<\/a><\/sup>  Bununla birlikte, torasik oulet sendromundan \u015f\u00fcpheleniliyorsa, te\u015fhisin do\u011fru olma olas\u0131l\u0131\u011f\u0131 \u00e7ok y\u00fcksektir. Amerika Birle\u015fik Devletleri&#8217;nde b\u00fcy\u00fck referans merkezinde yap\u0131lan \u00e7al\u0131\u015fmaya g\u00f6re, doktor sevkleri i\u00e7in do\u011fru tan\u0131 oran\u0131 %91, kendi ba\u015f\u0131na muracaat eden hastalar\u0131n i\u00e7in ise %97&#8217;dir. <sup><a href=\"#footnote_2_2782\" id=\"identifier_2_2782\" class=\"footnote-link footnote-identifier-link\" title=\"Likes K, Rochlin DH, Salditch Q, et al. Diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome is excellent. Ann Vasc Surg. 2014;28(5):1100-1105. https:\/\/doi.org\/10.1016\/j.avsg.2013.12.011\">2<\/a><\/sup>  Bu \u00e7al\u0131\u015fma, hastalar\u0131n kendisinin TOS&#8217;u doktorlar kadar iyi te\u015fhis etti\u011fini g\u00f6stermektedir.<\/p>\n\n<p class=\"\">TOS&#8217;tan \u015f\u00fcphelenmek ilk ad\u0131md\u0131r, ancak tan\u0131y\u0131 do\u011frulamak i\u00e7in bir\u00e7ok test yap\u0131lmal\u0131d\u0131r. TOS&#8217;un \u00e7e\u015fitli nedenleri oldu\u011fu i\u00e7in, tan\u0131 kapsaml\u0131 de\u011ferlendirme gerektirir. Ayr\u0131ca, farkl\u0131 nedenlerin tespit edilmesi i\u00e7in \u00e7e\u015fitli tan\u0131 y\u00f6ntemleri kullan\u0131lmas\u0131 laz\u0131m. TOS tan\u0131s\u0131 koymak, bir yapbozun par\u00e7alar\u0131n\u0131 bir araya getirmek gibidir. Deneyimli bir doktor ba\u015fkalar\u0131n\u0131n g\u00f6zden ka\u00e7\u0131rd\u0131klar\u0131n\u0131 g\u00f6rebilir ve en ufak belirtilerde bile TOS&#8217;u farkedebilir. Bu nedenle, hekimler sab\u0131rl\u0131, dikkatli, klinik muayene ve radyolojik g\u00f6r\u00fcnt\u00fcleme konusunda becerekli olmal\u0131.<\/p>\n\n<h2 class=\"wp-block-heading\" id=\"h-clinical-evaluation-nbsp\">Klinik de\u011ferlendirme <\/h2>\n\n<h3 class=\"wp-block-heading\" id=\"h-history\">Hikaye<\/h3>\n\n<p class=\"\">Dikkatli bir \u00f6yk\u00fc ve fizik muayene torasik outlet sendromundan \u015f\u00fcphelenmek i\u00e7in \u00f6nemli anahtarlard\u0131r. TOS kronik bir durumdur ve hastalar\u0131n \u015fikayetleri genelde uzun s\u00fcrelidir. Fiziksel aktivite s\u0131ras\u0131nda a\u011fr\u0131 veya \u00e7abuk yorulma gibi semptomlara \u00f6zelikle dikkat edilmeli. Bu ipu\u00e7lar\u0131, muayenenin ba\u015f\u0131ndan itibaren TOS&#8217;a i\u015faret eder. \u00c7ok say\u0131da TOS hastas\u0131 ile konu\u015ftuktan sonra, belirli bir &#8220;TOS prototipi&#8221; oldu\u011funu ke\u015ffettim. Bu prototipin farkedilmesi bir doktor i\u00e7in hem bilin\u00e7li ve sezgiseldir.<\/p>\n\n<h3 class=\"wp-block-heading\" id=\"h-physical-examination-nbsp\">Fizik muayene <\/h3>\n\n<p class=\"\">Kamburluk TOS olu\u015fmas\u0131 a\u00e7\u0131s\u0131ndan risk ta\u015f\u0131r, dolay\u0131s\u0131yla her zaman duru\u015f anormalliklerini kontrol ederim. TOS hastalar\u0131nda kifoz, <a href=\"https:\/\/kamranaghayev.com\/tr\/skolyoz\/\">skolyoz<\/a>, k\u00fcrek ve k\u00f6pr\u00fcc\u00fck kemikleri asimetrisi s\u0131k g\u00f6r\u00fcl\u00fcr. Deneyimsiz biri bu k\u00fc\u00e7\u00fck bulgular\u0131 farketmedi\u011fi i\u00e7in genelde atlanmaktad\u0131rlar. Boyun ve omuz b\u00f6lgesinin birle\u015fti\u011fi yerdeki a\u011fr\u0131 ve hassasiyet \u00e7ok tipiktir lakin TOS&#8217;a \u00f6zg\u00fc de\u011fildir. Torasik \u00e7\u0131k\u0131\u015f b\u00f6lgesine arkadan hafif\u00e7e vurmak a\u011fr\u0131y\u0131 tetikler ve TOS hastalar\u0131n neredeyse hepsinde g\u00f6r\u00fcld\u00fc\u011f\u00fc i\u00e7in tercih edilen testtir. <\/p>\n\n<h3 class=\"wp-block-heading\" id=\"h-neurological-assessment-nbsp\">N\u00f6rolojik muayene <\/h3>\n\n<p class=\"\">N\u00f6rolojik muayene kol ve elde g\u00fc\u00e7s\u00fczl\u00fck ve duyu kay\u0131plar\u0131na odaklanmal\u0131. N\u00f6rolojik muayne bulgular\u0131n\u0131 do\u011fru \u015fekilde yorumlanmas\u0131 i\u00e7in brakiyal pleksus anatomisi, sinir dallar\u0131n\u0131n deri\/adale da\u011f\u0131l\u0131m\u0131 konusunda derin bilgi gerektirir.<\/p>\n\n<h3 class=\"wp-block-heading\" id=\"h-motor-muscle-strength-examination-nbsp\">Motor (kas g\u00fcc\u00fc) muayenesi <\/h3>\n\n<p class=\"\">N\u00f6rolojik muayenenin bu b\u00f6l\u00fcm\u00fc kas atrofisi (erimesi) ve kas g\u00fc\u00e7s\u00fczl\u00fc\u011f\u00fcne odaklanmal\u0131d\u0131r.<\/p>\n\n<h4 class=\"wp-block-heading\" id=\"h-atrophy\">Atrofi<\/h4>\n\n<p class=\"\">Kas erimesi \u00f6zellikle \u00f6nemlidir \u00e7\u00fcnk\u00fc hastal\u0131\u011f\u0131n ileri a\u015famada oldu\u011funun g\u00f6stergesidir. Atrofi genellikle elin thenar (ba\u015fparmak) taraf\u0131nda belirgindir. Genelde iki eli yan yana koyarak atrofiyi kontrol etmek faydal\u0131d\u0131r. Bu \u015fekilde en az kas kayb\u0131 bile g\u00f6r\u00fclebilir. Atrofinin varl\u0131\u011f\u0131 bir &#8220;k\u0131rm\u0131z\u0131 uyar\u0131d\u0131r&#8221; \u00e7\u00fcnk\u00fc sorunun uzun s\u00fcredir devam etti\u011fini ve kal\u0131c\u0131 etkiler yaratmaya ba\u015flad\u0131\u011f\u0131n\u0131 g\u00f6sterir.<\/p>\n\n<h4 class=\"wp-block-heading\" id=\"h-muscle-weakness\">G\u00fccs\u00fczl\u00fck<\/h4>\n\n<p class=\"\">T\u00fcm el kaslar\u0131 brakiyal pleksusun alt k\u0131sm\u0131ndan, yani C8 ve T1 sinir k\u00f6klerinden innervasyon al\u0131r. TOS hastalar\u0131nda muayene s\u0131ras\u0131nda genellikle <strong>t\u00fcm el kaslar\u0131 <\/strong>zay\u0131ft\u0131r. Bu klinik bulgu, TOS&#8217;u karpal t\u00fcnel veya k\u00fcbital t\u00fcnel sendromlar\u0131 gibi di\u011fer sinir tuzak n\u00f6ropatilerden ay\u0131r\u0131r. Karpal t\u00fcnel sendromunda el bile\u011fi b\u00f6lgesinde hipertrofik (kal\u0131nla\u015fm\u0131\u015f) transvers karpal ligaman median siniri s\u0131k\u0131\u015ft\u0131r\u0131r. Baz\u0131 (ama hepsi de\u011fil) el adaleleri sinir ezilmesinin sonucu olarak zay\u0131flar. Bunlar LOAF kaslar\u0131d\u0131r &#8211; L: lateral iki lumbricals, O: opponens pollicis, A: abductor pollicis brevis, F: flexor pollicis brevis. Kubital kanal sendromunda geride kalan kaslar\u0131 etkilenir. TOS hastalar\u0131n\u0131n baz\u0131lar\u0131na yanl\u0131\u015f olarak karpal veya k\u00fcbital t\u00fcnel sendromu tan\u0131s\u0131 konur ve hatta gereksiz ameliyatlar yap\u0131l\u0131r. <\/p>\n\n<h3 class=\"wp-block-heading\" id=\"h-sensory-skin-feeling-examination-nbsp\">Duyusal (cilt hissi) muayenesi <\/h3>\n\n<p class=\"\">N\u00f6rojenik TOS \u00e7e\u015fitli duyusal bozukluklara neden olur. Bunlar etkilenen b\u00f6lgede a\u011fr\u0131, parestezi (kar\u0131ncalanma), uyu\u015fma gibi rahats\u0131zl\u0131klar\u0131 i\u00e7erir. Do\u011fru duyu muayenesi TOS tan\u0131s\u0131na \u00f6nemli \u00f6l\u00e7\u00fcde katk\u0131da bulunabilir. Ne yaz\u0131k ki bu, \u00e7e\u015fitli nedenlerden dolay\u0131 nadiren yap\u0131lmaktad\u0131r. \u0130lk olarak, b\u00fct\u00fcn kolun t\u00fcm duyu tiplerini i\u00e7eren (dokunma, a\u011fr\u0131, s\u0131cakl\u0131k, titre\u015fim) kapsaml\u0131 muayenesi zaman al\u0131c\u0131d\u0131r. \u0130\u015fleri h\u0131zland\u0131rmak i\u00e7in olduk\u00e7a k\u00fc\u00e7\u00fck alanlar \u00fcst\u00fck\u00f6r\u00fc olarak muayene edilir. \u0130kinci olarak, \u00e7o\u011fu hekim kol innervasyonunun karma\u015f\u0131k anatomisi hakk\u0131nda derin bilgiye sahip de\u011fil. <\/p>\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;69d27ee6babab&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"69d27ee6babab\" class=\"wp-block-image aligncenter size-full is-resized wp-lightbox-container\"><img decoding=\"async\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/kamranaghayev.com\/wp-content\/uploads\/2023\/12\/thoracic-outlet-syndrome-diagnosis-content-1-e1741017673500.webp\" alt=\"\" class=\"wp-image-596\" style=\"width:600px\"\/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"B\u00fcy\u00fct\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><\/figure>\n\n<p class=\"\">Tecr\u00fcbelerime g\u00f6re, \u00e7o\u011fu doktor torasik \u00e7\u0131k\u0131\u015f sendromunu ulnar sinir s\u0131k\u0131\u015fmas\u0131 ile kar\u0131\u015ft\u0131r\u0131yor. Brakiyal pleksusun alt k\u0131sm\u0131 C8, T1 sinir k\u00f6klerinden ve onlar\u0131n birle\u015fmesi ile olu\u015fan inferior trunkustan olu\u015fur. Brakiyal pleksusun bu k\u0131sm\u0131 kompresyona meyillidir ve TOS&#8217;tan en s\u0131k etkilenen k\u0131s\u0131md\u0131r. \u0130nferior trunkus kolun, \u00f6n kolun ve elin i\u00e7 taraf\u0131n\u0131n derisini innerve eden birka\u00e7 dal verir. Bu nedenle, bu alandaki duyu bozukluklar\u0131 TOS&#8217;a \u00f6zg\u00fcd\u00fcr. Doktorlar taraf\u0131ndan yap\u0131lan yayg\u0131n hata, i\u00e7 \u00f6nkol uyu\u015fmas\u0131n\u0131 (hipoestezisini) ulnar sinir s\u0131k\u0131\u015fmas\u0131na ba\u011flamakt\u0131r. <strong>Ulnar sinirin <\/strong><strong>\u00f6n kolda <\/strong>duyu innervasyonu yoktur. Ba\u015fka bir deyi\u015fle, TOS&#8217;ta etkilenen duyusal alan ulnar sinir alan\u0131n\u0131 i\u00e7erir ancak bununla s\u0131n\u0131rl\u0131 de\u011fildir. Kolun ve \u00f6n kolun i\u00e7 taraf\u0131ndaki deri, di\u011fer sinirlerden &#8211; interkostobrakialis ve medial kutan\u00f6z antebrakial sinirlerden innervasyon al\u0131r. Daha \u00f6nce belirtildi\u011fi gibi n\u00f6rojenik TOS \u00e7o\u011funlukla C8\/T1\/inferior trunkus ve dallar\u0131n\u0131 etkiler &#8211; yani ulnar, medial cutaneus antebrachial, intercostobrachial. T\u00fcm bu sinirler aras\u0131nda medial kutan\u00f6z antebrakiyal sinir en y\u00fcksek tan\u0131 de\u011ferine sahiptir ve tutulumu TOS i\u00e7in \u00e7ok spesifiktir. Ancak bu sinirin cilt b\u00f6lgesi nadiren muayene edilir ve edildi\u011finde hipoestezi yanl\u0131\u015fl\u0131kla ulnar sinir s\u0131k\u0131\u015fmas\u0131na ba\u011flan\u0131r. <\/p>\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;69d27ee6bb3b2&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"69d27ee6bb3b2\" class=\"wp-block-image aligncenter size-large is-resized wp-lightbox-container\"><img decoding=\"async\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/kamranaghayev.com\/wp-content\/uploads\/2023\/12\/thoracic-outlet-syndrome-diagnosis-content-2-e1741017612525.jpg\" alt=\"\" class=\"wp-image-597\" style=\"width:600px\"\/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"B\u00fcy\u00fct\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\"><em>TOS ve ulnar sinir s\u0131k\u0131\u015fmas\u0131nda etkilenen tipik cilt b\u00f6lgeleri. TOS&#8217;ta etkilenen cildin ulnar sinir cilt alan\u0131n\u0131 i\u00e7erdi\u011fini ancak \u00e7ok daha b\u00fcy\u00fck oldu\u011funu unutmay\u0131n. Klinisyenler TOS ile ili\u015fkili duyu bozukluklar\u0131n\u0131 ulnar sinir s\u0131k\u0131\u015fmas\u0131 olarak yanl\u0131\u015f yorumlad\u0131klar\u0131 i\u00e7in bu durum kafa kar\u0131\u015ft\u0131r\u0131c\u0131d\u0131r. <\/em><\/figcaption><\/figure>\n\n<h3 class=\"wp-block-heading\" id=\"h-provocative-maneuvers\">Provokatif manevralar<\/h3>\n\n<p class=\"\">Provokatif testler klinik muayenenin \u00f6nemli bir par\u00e7as\u0131d\u0131r. Bu testlerin amac\u0131, bir tak\u0131m klinik manevralar kullanarak TOS semptomlar\u0131n ortaya \u00e7\u0131kmas\u0131n\u0131 te\u015fvik etmektir.<\/p>\n\n<ul class=\"wp-block-list\">\n<li class=\"\">Elevated arm stress test (EAST veya Roos testi). TOS tan\u0131s\u0131nda en s\u0131k kullan\u0131lan ve \u00f6nemli testtir. Kollar yukar\u0131 kald\u0131r\u0131l\u0131r ve hasta ellerini a\u00e7\u0131p kapat\u0131r. Manevra s\u0131ras\u0131nda erken yorulma, a\u011fr\u0131 ve uyu\u015fma gibi bulgular\u0131n ortaya \u00e7\u0131kmas\u0131 torasik outlet sendromunun bir g\u00f6stergesidir. <\/li>\n\n\n\n<li class=\"\">Upper limb tension tests (ULTT&#8217;ler). Bunlar, kolun \u00e7e\u015fitli sinirlerini de\u011ferlendirmeyi ama\u00e7layan testlerdir. Bu testlerden biri kollar abduksiyonda, avu\u00e7 i\u00e7leri dorsifleksiyonda ve ba\u015f e\u011fik olarak yap\u0131l\u0131r. A\u011fr\u0131 hissedilirse test pozitif kabul edilir. <\/li>\n\n\n\n<li class=\"\">Adson testi s\u0131kl\u0131kla arteriyel kompresyonu te\u015fhis etmek i\u00e7in kullan\u0131l\u0131r. Ancak bu test son derece yan\u0131lt\u0131c\u0131d\u0131r ve pratikte \u00e7ok az de\u011feri var. Adson testi, TOS varl\u0131\u011f\u0131n\u0131n kan\u0131t\u0131 olarak belirli bir pozisyonda subklavyen arter s\u0131k\u0131\u015fmas\u0131 ve buna ba\u011fl\u0131 radyal nabz\u0131n kaybolmas\u0131na odakl\u0131d\u0131r. Bu test, bir\u00e7ok normal bireyde pozitif ve TOS hastalar\u0131nda s\u0131kl\u0131kla negatif oldu\u011fu i\u00e7in \u00f6zg\u00fcll\u00fck ve duyarl\u0131l\u0131k a\u00e7\u0131s\u0131ndan yetersizdir. <\/li>\n<\/ul>\n\n<h2 class=\"wp-block-heading\" id=\"h-radiological-examination-nbsp\">Radyolojik inceleme <\/h2>\n\n<h3 class=\"wp-block-heading\" id=\"h-x-ray\">R\u00f6ntgen<\/h3>\n\n<p class=\"\">Basit kemik anormalliklerinin te\u015fhisi i\u00e7in \u00e7ok faydal\u0131 bir y\u00f6ntemdir. \u00d6rne\u011fin, aksesuar (ek) servikal kaburgalar r\u00f6ntgenlerde g\u00f6r\u00fcl\u00fcr. Ancak bazen bu kaburgalar uzun C7 transvers prosesleri \u015feklinde olabilir ve bu durum tan\u0131y\u0131 zorla\u015ft\u0131r\u0131r. K\u00f6t\u00fc iyile\u015fmi\u015f birinci kaburga ve k\u00f6pr\u00fcc\u00fck kemi\u011fi k\u0131r\u0131klar\u0131, anormal ve yanl\u0131\u015f yerle\u015fmi\u015f kemikler gibi di\u011fer anomalileri r\u00f6ntgenlerde farketmek zordur. R\u00f6ntgenler TOS&#8217;u ileri <a href=\"https:\/\/kamranaghayev.com\/tr\/servikal-disk-herniasyonu\/\">servikal disk hastal\u0131\u011f\u0131ndan<\/a> ay\u0131rt etmek i\u00e7in yararl\u0131d\u0131r. N\u00f6rojenik TOS&#8217;lu hastalarda s\u0131kl\u0131kla lordoz kayb\u0131 (boyun d\u00fczle\u015fmesi) ve hatta kifoz g\u00f6r\u00fcl\u00fcr ve bu durumlar yanl\u0131\u015fl\u0131kla <a href=\"https:\/\/kamranaghayev.com\/tr\/servikal-disk-herniasyonu\/\">servikal disk herniasyonuna<\/a> ba\u011flan\u0131r. Asl\u0131nda TOS&#8217;da lordoz kayb\u0131 \u00e7ok yayg\u0131nd\u0131r. R\u00f6nten g\u00f6r\u00fcnt\u00fclemenin ana dezavantaj\u0131 iyonla\u015ft\u0131r\u0131c\u0131 radyasyon i\u00e7ermesidir.<\/p>\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img decoding=\"async\" src=\"https:\/\/kamranaghayev.com\/wp-content\/uploads\/2024\/01\/Accessory-1st-rib.jpg\" alt=\"\" class=\"wp-image-2611\" style=\"width:399px;height:auto\"\/><figcaption class=\"wp-element-caption\">Sol tarafta aksesuar servikal kostay\u0131 (oklar) g\u00f6steren r\u00f6ntgen g\u00f6r\u00fcnt\u00fcs\u00fc . <\/figcaption><\/figure>\n\n<h3 class=\"wp-block-heading\" id=\"h-ct-scan\">BT<\/h3>\n\n<p class=\"\">Bu, kemik yap\u0131lar\u0131n en ufak detaylar\u0131na kadar incelenmeyi sa\u011flayan g\u00f6r\u00fcn\u00fcleme y\u00f6ntemidir. Yumu\u015fak doku daha az olarak g\u00f6sterilir. BT anjiyografi (BTA) subklavyen arter ve ven g\u00f6r\u00fcnt\u00fclemesi i\u00e7in m\u00fckemmeldir. \u00dc\u00e7 boyutlu BT\/BTA rekonstr\u00fcksiyonlar\u0131 preoperatif de\u011ferlendirme i\u00e7in \u00f6zellikle yararl\u0131 olabilir. Kompresyonu vurgulamak i\u00e7in provokatif kol pozisyonu ile birlikte BT\/BTA, kompresyonun yerini ve nedenini y\u00fcksek \u00e7\u00f6z\u00fcn\u00fcrl\u00fckle g\u00f6sterebilir. BT&#8217;nin ana dezavantaj\u0131 iyonla\u015ft\u0131r\u0131c\u0131 radyasyondur.<\/p>\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;69d27ee6bcde6&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"69d27ee6bcde6\" class=\"wp-block-image aligncenter size-full is-resized wp-lightbox-container\"><img decoding=\"async\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/kamranaghayev.com\/wp-content\/uploads\/2024\/01\/accessory-rib-CT-angiography.jpg\" alt=\"\" class=\"wp-image-2617\" style=\"width:400px\"\/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"B\u00fcy\u00fct\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\"><em>TOS&#8217;lu bir hastadan al\u0131nan 3 boyutlu BT anjiyografik rekonstr\u00fcksiyon. Subklavyen arterin aksesuar kaburga \u00fczerinden ge\u00e7erken darald\u0131\u011f\u0131na dikkat edin. Aksesuar kaburga birinci kaburga ile anormal bir eklem yapmaktad\u0131r (beyaz daire).<\/em><\/figcaption><\/figure>\n\n<h3 class=\"wp-block-heading\" id=\"h-ultrasonography-usg-and-duplex-scan\">Ultrasonografi (USG) ve Doppler<\/h3>\n\n<p class=\"\">USG t\u0131pta uzun s\u00fcredir kullan\u0131lmaktad\u0131r. Ancak ultrasonografinin TOS tan\u0131s\u0131 i\u00e7in kullan\u0131lmas\u0131 nispeten yak\u0131n bir tarihte ger\u00e7ekle\u015fmi\u015ftir. Torasik \u00e7\u0131k\u0131\u015f b\u00f6lgesinin y\u00fcksek \u00e7\u00f6z\u00fcn\u00fcrl\u00fckl\u00fc USG&#8217;si n\u00f6ro-vask\u00fcler demetin s\u0131k\u0131\u015fmas\u0131n\u0131 do\u011frudan g\u00f6sterebilir. Doppler ultrasonografi USG&#8217;nin bir \u00e7e\u015fididir ve kan ak\u0131\u015f\u0131n\u0131 g\u00f6sterir. \u00d6zellikle arteriyel ve ven\u00f6z TOS vakalar\u0131nda faydal\u0131d\u0131r. USG&#8217;nin en b\u00fcy\u00fck avantajlar\u0131ndan biri &#8220;ger\u00e7ek zamanl\u0131&#8221; olmas\u0131d\u0131r. Bu, g\u00f6r\u00fcnt\u00fclemenin \u00e7ok h\u0131zl\u0131 oldu\u011fu ve mevcut durumu yans\u0131tt\u0131\u011f\u0131 anlam\u0131na gelir. Bu \u00f6zellik, normal ve \u00e7e\u015fitli provokatif poziyonlarda g\u00f6r\u00fct\u00fclemeye izin verir. USG iyonla\u015ft\u0131r\u0131c\u0131 radyasyon i\u00e7ermez ve en zarars\u0131z g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemidir. Ayn\u0131 zamanda nispeten ucuzdur. USG&#8217;nin temel dezavantaj\u0131 subjektif olmas\u0131d\u0131r. Bu, sonu\u00e7lar\u0131n incelemeyi yapan ki\u015fiye ba\u011fl\u0131 oldu\u011fu anlam\u0131na gelir. <\/p>\n\n<h3 class=\"wp-block-heading\" id=\"h-mri\">MRG<\/h3>\n\n<p class=\"\">Yumu\u015fak dokuyu g\u00f6stermek i\u00e7in en etkili g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemidir. Di\u011fer g\u00f6r\u00fcnt\u00fcleme se\u00e7enekleriyle kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda MR en y\u00fcksek \u00e7\u00f6z\u00fcn\u00fcrl\u00fck kalitesine sahip. TOS&#8217;u <a href=\"https:\/\/kamranaghayev.com\/tr\/servikal-disk-herniasyonu\/\">servikal disk hastal\u0131\u011f\u0131ndan<\/a> ay\u0131rt edebilir. N\u00f6tr konumdaki standart MRG \u00e7ok kullan\u0131\u015fl\u0131 de\u011fildir. Ancak kollar ba\u015f\u0131n \u00fczerinde, yani provokatif pozisyonda yap\u0131lan MRG TOS i\u00e7in en iyi g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemidir. Bu pozisyonda klavikula birinci kaburgaya yakla\u015farak &#8220;f\u0131nd\u0131kk\u0131ran etkisi&#8221; yarat\u0131r ve n\u00f6ro-vask\u00fcler kompresyona neden olur. MR bu s\u0131k\u0131\u015fmay\u0131 birebir g\u00f6sterebiliyor. Standart ve provokatif g\u00f6r\u00fcnt\u00fclemenin yan\u0131 s\u0131ra bir\u00e7ok farkl\u0131 MR protokol\u00fc var. \u00d6rne\u011fin, MR n\u00f6rografi brakiyal pleksusun kendisini y\u00fcksek \u00e7\u00f6z\u00fcn\u00fcrl\u00fckle g\u00f6sterebiliyor. Dif\u00fczyon tens\u00f6r g\u00f6r\u00fcnt\u00fcleme (DTI), brakiyal pleksus i\u00e7indeki lifleri g\u00f6sterir. MR anjiyografi veya MRA subklavyen damarlardaki kan ak\u0131\u015f\u0131n\u0131 g\u00f6sterebilir. MR \u00e7ok g\u00fcvenlidir \u00e7\u00fcnk\u00fc iyonla\u015ft\u0131r\u0131c\u0131 radyasyon i\u00e7ermez. MRG&#8217;nin dezavantajlar\u0131 uzun s\u00fcre almas\u0131 ve pahal\u0131 olmas\u0131d\u0131r. <\/p>\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img decoding=\"async\" src=\"https:\/\/kamranaghayev.com\/wp-content\/uploads\/2024\/01\/MRI-arms-up-brachial-plexus-compression-1.jpeg\" alt=\"\" class=\"wp-image-2621\" style=\"width:433px;height:auto\"\/><figcaption class=\"wp-element-caption\"><em>Klavikula ile birinci kaburga aras\u0131nda brakiyal pleksus s\u0131k\u0131\u015fmas\u0131n\u0131 g\u00f6steren kollar yukar\u0131da \u00f6rnek bir MR g\u00f6r\u00fcnt\u00fcs\u00fc.<\/em><\/figcaption><\/figure>\n\n<h2 class=\"wp-block-heading\" id=\"h-electromyography-emg-and-nerve-conduction-studies\">EMG<\/h2>\n\n<p class=\"\">Bir\u00e7ok uzman elektromiyografi (EMG) ve elektron\u00f6rografiyi (ENG, sinir iletim \u00e7al\u0131\u015fmalar\u0131) torasik \u00e7\u0131k\u0131\u015f sendromu tan\u0131s\u0131n\u0131n \u00f6nemli bir par\u00e7as\u0131 olarak g\u00f6rmektedir. Teoride \u00e7ok mant\u0131kl\u0131. TOS brakiyal pleksus sinirlerini etkiler ve EMG hasar\u0131 tespit edebilmelidir. Ancak uygulamaya gelince durum \u00e7ok daha farkl\u0131d\u0131r. EMG&#8217;nin TOS te\u015fhisinde ba\u015far\u0131s\u0131z olmas\u0131n\u0131n birka\u00e7 nedeni vard\u0131r.<\/p>\n\n<ol class=\"wp-block-list\">\n<li class=\"\">Sinir iletim \u00e7al\u0131\u015fmalar\u0131, belirli bir alandaki sinir iletiminin \u00e7e\u015fitli parametrelerini (h\u0131z, genlik, gecikme vb.) \u00f6l\u00e7er. Sinirlerin cilde yak\u0131n oldu\u011fu b\u00f6lgelerde de\u011ferlendirme kolayd\u0131r. Bu nedenle, karpal t\u00fcnel ve k\u00fcbital kanal sendromlar\u0131 gibi tuzak n\u00f6ropatileri, y\u00fczeysel oldu\u011fu i\u00e7in kolayca te\u015fhis edilir. Brakiyal pleksus \u00e7ok derindir ve do\u011frudan incelenemez. <\/li>\n\n\n\n<li class=\"\">Sinir iletimi genellikle etkilenen b\u00f6lgenin proksimaline ve distaline problar yerle\u015ftirilerek \u00f6l\u00e7\u00fcl\u00fcr. Brakiyal pleksus omurili\u011fe \u00e7ok yak\u0131nd\u0131r ve proksimal prob yerle\u015ftirilemez.<\/li>\n\n\n\n<li class=\"\">TOS&#8217;ta s\u0131k\u0131\u015ft\u0131rma aral\u0131kl\u0131d\u0131r, yani kol yukar\u0131dayken meydana gelir. Bu nedenle standart EMG (kollar a\u015fa\u011f\u0131da) kompresyonu g\u00f6steremez.<\/li>\n\n\n\n<li class=\"\">EMG ve ENG i\u00e7in normal de\u011ferler \u00e7ok de\u011fi\u015fkendir ve sonu\u00e7lar \u00e7o\u011funlukla incelemeyi yapan ki\u015fiye ba\u011fl\u0131d\u0131r, bu da testi \u00e7ok g\u00fcvenilmez k\u0131lar.<\/li>\n<\/ol>\n\n<p class=\"\">EMG&#8217;nin TOS i\u00e7in duyarl\u0131l\u0131\u011f\u0131 yak\u0131n tarihli bir meta-analiz \u00e7al\u0131\u015fmas\u0131nda incelenmi\u015ftir. Bu \u00e7al\u0131\u015fma EMG ile ilgili <strong>t\u00fcm \u00e7al\u0131\u015fmalar\u0131n<\/strong> derinlemesine analizini yapm\u0131\u015f ve &#8220;Elektron\u00f6romiyografinin bu noktada NTOS i\u00e7in ger\u00e7ek bir tan\u0131 arac\u0131 olarak kabul edilemeyece\u011fi&#8221; sonucuna varm\u0131\u015ft\u0131r. <sup><a href=\"#footnote_3_2782\" id=\"identifier_3_2782\" class=\"footnote-link footnote-identifier-link\" title=\"Daley P, Pomares G, Gross R, et al. Use of Electroneuromyography in the Diagnosis of Neurogenic Thoracic Outlet Syndrome: A Systematic Review and Meta-Analysis. J Clin Med. 2022;11(17). https:\/\/doi.org\/10.3390%2Fjcm11175206\">3<\/a><\/sup>   Bununla birlikte, birka\u00e7 \u00e7al\u0131\u015fma medial kutan\u00f6z antebrakiyal sinir EMG&#8217;si gibi spesifik EMG testlerinin TOS hastalar\u0131nda de\u011ferli oldu\u011funu g\u00f6stermi\u015ftir. Ancak bu testler standart EMG&#8217;nin bir par\u00e7as\u0131 de\u011fildir ve nadiren yap\u0131l\u0131r. Bu nedenle, pratik a\u00e7\u0131dan bak\u0131ld\u0131\u011f\u0131nda EMG g\u00fcn\u00fcm\u00fczde yarars\u0131z bir testtir. <\/p>\n\n<p class=\"\">EMG ile ilgili g\u00fcn\u00fcm\u00fczde b\u00fcy\u00fck bir sorun var. Bahsetti\u011fimiz gibi, TOS&#8217;u tespit etmede \u00e7ok az de\u011feri vard\u0131r ancak doktorlar geleneksel olarak EMG&#8217;ye g\u00fcvenmektedir. Ge\u00e7mi\u015fte, ileri g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemlerinin olmad\u0131\u011f\u0131 d\u00f6nemlerde hekimler tan\u0131 i\u00e7in EMG&#8217;yi kullanm\u0131\u015flard\u0131r. O zaman bile, 1970&#8217;lerde \u00f6nde gelen TOS uzmanlar\u0131 EMG&#8217;yi ele\u015ftirmi\u015ftir <sup><a href=\"#footnote_4_2782\" id=\"identifier_4_2782\" class=\"footnote-link footnote-identifier-link\" title=\"Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Am J Surg. 1976;132(6): 771-778. https:\/\/doi.org\/10.1016\/0002-9610(76)90456-6.\">4<\/a><\/sup> G\u00fcn\u00fcm\u00fczde, yanl\u0131\u015f negatif EMG sonu\u00e7lar\u0131 torasik \u00e7\u0131k\u0131\u015f sendromunu d\u0131\u015flamak i\u00e7in gerek\u00e7e olarak kullan\u0131lmaktad\u0131r. Bu durum, hastalar\u0131n tedavi bulamamas\u0131n\u0131n ve uzun y\u0131llar boyunca ac\u0131 \u00e7ekmelerinin ana nedenidir. <\/p>\n\n<h2 class=\"wp-block-heading\" id=\"h-next-standard-thoracic-outlet-syndrome-surgery\">Sonraki: <a href=\"https:\/\/kamranaghayev.com\/tr\/standart-torasik-outlet-sendromu-ameliyatlari\/\">Standart Torasik Outlet Sendromu Ameliyatlar\u0131<\/a><\/h2>\n\n<h2 class=\"wp-block-heading\" id=\"h-references\">Referanslar<\/h2>\n<ol class=\"footnotes\"><li id=\"footnote_1_2782\" class=\"footnote\">Landry GJ, Moneta GL, Taylor LM, Jr., Edwards JM, Porter JM. Long-term functional outcome of neurogenic thoracic outlet syndrome in surgically and conservatively treated patients. <em>J Vasc Surg. <\/em>2001;33(2):312-317; discussion 317-319. <a href=\"https:\/\/doi.org\/10.1067\/mva.2001.112950\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1067\/mva.2001.112950<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_1_2782\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_2_2782\" class=\"footnote\">Likes K, Rochlin DH, Salditch Q, et al. Diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome is excellent. <em>Ann Vasc Surg. <\/em>2014;28(5):1100-1105. <a href=\"https:\/\/doi.org\/10.1016\/j.avsg.2013.12.011\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/j.avsg.2013.12.011<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_2_2782\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_3_2782\" class=\"footnote\">Daley P, Pomares G, Gross R, et al. Use of Electroneuromyography in the Diagnosis of Neurogenic Thoracic Outlet Syndrome: A Systematic Review and Meta-Analysis. J Clin Med. 2022;11(17). <a href=\"\">https:\/\/doi.org\/10.3390%2Fjcm11175206<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_3_2782\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_4_2782\" class=\"footnote\">Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. <em>Am J Surg.<\/em> 1976;132(6): 771-778. <a href=\"https:\/\/doi.org\/10.1016\/0002-9610(76)90456-6\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/0002-9610(76)90456-6<\/a>.<span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_4_2782\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>Torasik outlet sendromu te\u015fhisi: Tan\u0131da yer alan y\u00f6ntemleri, temel testleri ve prosed\u00fcrleri ke\u015ffedin ve tedavi i\u00e7in sonraki ad\u0131mlar hakk\u0131nda bilgi edinin.<\/p>\n","protected":false},"author":2,"featured_media":3973,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","footnotes":""},"categories":[24,35],"tags":[],"class_list":["post-2782","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hastaliklar","category-torasik-outlet-cikis-sendromu"],"acf":[],"_links":{"self":[{"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/posts\/2782","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/comments?post=2782"}],"version-history":[{"count":0,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/posts\/2782\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/media\/3973"}],"wp:attachment":[{"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/media?parent=2782"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/categories?post=2782"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/tags?post=2782"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}