{"id":2790,"date":"2024-11-20T23:48:25","date_gmt":"2024-11-20T23:48:25","guid":{"rendered":"https:\/\/kamranaghayev.com\/torasik-outlet-sendromu-nedir\/"},"modified":"2025-05-11T12:46:56","modified_gmt":"2025-05-11T12:46:56","slug":"torasik-outlet-sendromu-nedir","status":"publish","type":"post","link":"https:\/\/kamranaghayev.com\/tr\/torasik-outlet-sendromu-nedir\/","title":{"rendered":"Torasik \u00e7\u0131k\u0131\u015f sendromu nedir?"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\" id=\"h-thoracic-outlet-syndrome-definition\">Torasik outlet sendromunun tan\u0131m\u0131.<\/h2>\n\n\n\n<p>Torasik \u00e7\u0131k\u0131\u015f sendromu veya k\u0131saca TOS, g\u00f6\u011f\u00fcs bo\u015flu\u011funun \u00fcst k\u0131smda, torasik \u00e7\u0131k\u0131\u015f b\u00f6lgesinde bulunan sinir ve\/veya ana kan damarlar\u0131n\u0131n s\u0131k\u0131\u015fmas\u0131na ba\u011fl\u0131 geli\u015fen klinik tablodur.<\/p>\n\n\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;69ecea1bdd88d&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"69ecea1bdd88d\" class=\"wp-block-image alignright 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\/TOS-area--e1741017584603.jpg\" alt=\"\" class=\"wp-image-2646\" style=\"width:300px\"\/><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\n\n<h2 class=\"wp-block-heading\" id=\"h-what-is-the-thoracic-outlet-area\">Torasik \u00e7\u0131k\u0131\u015f b\u00f6lgesi nedir?<\/h2>\n\n\n\n<p class=\"has-text-align-left\">Torasik \u00e7\u0131k\u0131\u015f veya outlet, g\u00f6\u011f\u00fcs bo\u015flu\u011funun \u00fcst k\u0131sm\u0131nda konumlanan kalp \u015feklinde bir aland\u0131r. Yap\u0131sal olarak bu b\u00f6lge birinci torasik vertebra, sol ve sa\u011f birinci kaburgalar ve sternum kemi\u011fi ile s\u0131n\u0131rl\u0131d\u0131r. \u00d6nemli organlar\u0131 i\u00e7erir ve bu nedenle b\u00fcy\u00fck klinik ehemiyete sahiptir.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-what-structures-are-affected-by-tos\">TOS hastal\u0131\u011f\u0131 hangi yap\u0131lar\u0131 etkiler?<\/h2>\n\n\n\n<p>Torasik \u00e7\u0131k\u0131\u015f sendromunda n\u00f6ro-vask\u00fcler demet bask\u0131 alt\u0131ndad\u0131r. \u00d6zetle, bu demet brakiyal pleksus, subklavyen arter ve veni i\u00e7erir.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-brachial-plexus\">Brakiyal pleksus<\/h3>\n\n\n\n<p>Omurilikten ayr\u0131lan be\u015f sinir (C5, C6, C7, C8 ve T1), <em><strong>brakiyal pleksus<\/strong><\/em> ad\u0131 verilen karma\u015f\u0131k bir a\u011f olu\u015fturur. Brakiyal pleksus devam\u0131nda boyun, omuz, \u00fcst g\u00f6\u011f\u00fcs ve kola giden sinir dallar\u0131na ayr\u0131l\u0131r. Temel olarak bu sinirler omurilik ile kol aras\u0131nda uyar\u0131lar ta\u015fmaktad\u0131rlar. Kol ve omuz g\u00f6revlerinin her y\u00f6n\u00fcn\u00fc kontrol ederler: cilt hissiyat\u0131, kas hareketleri, terleme, kan damarlar\u0131n\u0131n tonusu vb. <\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-subclavian-vessels\">Subklavyen damarlar<\/h3>\n\n\n\n<p>Subklavyen arter ve ven, kola kan ak\u0131\u015f\u0131n\u0131 sa\u011flayan ana damarlard\u0131r. Kola giden yolda brakiyal pleksusun yan\u0131nda, birinci kaburgan\u0131n \u00fczerinden ge\u00e7erler. <\/p>\n\n\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;69ecea1bde4d1&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"69ecea1bde4d1\" 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\/what-is-thoracic-outlet-syndrome-content-2-e1741017530725.webp\" alt=\"\" class=\"wp-image-610\" 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>Torasik \u00e7\u0131k\u0131\u015f b\u00f6lgesinde brakiyal pleksus, subklavyen arter ve venin seyrini g\u00f6steren sanatsal \u00e7izim. T\u00fcm yap\u0131lar\u0131n birinci kaburgan\u0131n \u00fczerinden ge\u00e7ti\u011fine dikkat edin. <\/em><\/figcaption><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-anatomical-relationships-in-thoracic-outlet-area\">Torasik \u00e7\u0131k\u0131\u015f b\u00f6lgesindeki anatomik ili\u015fkiler<\/h3>\n\n\n\n<p>Damarlar, kaburgan\u0131n hemen \u00fcst\u00fcnden, kemi\u011fe temas ederek seyreder, hatta subklavyen arter ve venin dokundu\u011fu yerde kaburga kemi\u011finde hafif oluklar mevcut. Benzer \u015fekilde, C8, T1 sinir k\u00f6kleri ve brakiyal pleksusun alt trunkusu do\u011frudan birinci kaburgaya temas eder. Brakiyal pleksus ve subklavyen arter, skalen \u00fc\u00e7gen ad\u0131 verilen dar bir anatomik pencereden ge\u00e7er. Bu \u00fc\u00e7genin kenarlar\u0131 birinci kaburga, \u00f6n ve orta adet skalen adaleleri taraf\u0131ndan olu\u015fmaktad\u0131r. Subklavian ven kosto-klavik\u00fcler veya ven\u00f6z \u00fc\u00e7genden ge\u00e7er. Bu \u00fc\u00e7gen subklavius, anterior skalen adaleleri ve birinci kaburgadan olu\u015fur. Subklavian ven bu \u00fc\u00e7gen i\u00e7inde birinci kaburga ila subklavius kas\u0131 aras\u0131nda s\u0131k\u0131\u015fmaya meyillidir.      <\/p>\n\n\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;69ecea1bdec77&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"69ecea1bdec77\" 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\/what-is-thoracic-outlet-syndrome-content-3.webp\" alt=\"\" class=\"wp-image-611\" style=\"width:430px;height:auto\"\/><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>Torasik \u00e7\u0131k\u0131\u015f sendromunda g\u00f6r\u00fclen s\u0131k\u0131\u015fma b\u00f6lgeleri. Skalen \u00fc\u00e7gen, kosto-klavik\u00fcler aral\u0131k ve subpektoral alan. <\/em><\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-thoracic-outlet-syndrome-forms\">Torasik \u00e7\u0131k\u0131\u015f sendromu formlar\u0131<\/h2>\n\n\n\n<p>TOS hastal\u0131\u011f\u0131n\u0131n \u00fc\u00e7 klinik formu vard\u0131r:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>N\u00f6rojenik TOS &#8211; nTOS<\/strong>. En yayg\u0131n formdur &#8211; vakalar\u0131n yakla\u015f\u0131k %80-85&#8217;ni olu\u015fturmaktad\u0131r. Kompresyon brakiyal pleksusu etkiler ve sinir bas\u0131s\u0131na ba\u011fl\u0131 semptomlar geli\u015fir.   <\/li>\n\n\n\n<li><strong>Ven\u00f6z TOS &#8211; vTOS.<\/strong> \u00c7ok daha az yayg\u0131n &#8211; vakalar\u0131n yakla\u015f\u0131k %10-15&#8217;i. S\u0131k\u0131\u015fma subklavyen veni etkiler ve koldan yetersiz kan d\u00f6n\u00fc\u015f\u00fcne ba\u011fl\u0131 semptomlar geli\u015fir. <\/li>\n\n\n\n<li><strong>Arteriyel TOS &#8211; aTOS<\/strong>. En az g\u00f6r\u00fclen formdur &#8211; t\u00fcm vakalar\u0131n yakla\u015f\u0131k %1-2&#8217;si. S\u0131k\u0131\u015fma subklavyen arteri etkiler ve kolda yetersiz kan ak\u0131\u015f\u0131na ba\u011fl\u0131 semptomlar geli\u015fir.   <\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-causes-of-thoracic-outlet-syndrome\">Torasik \u00e7\u0131k\u0131\u015f sendromunun nedenleri<\/h2>\n\n\n\n<p>Torasik \u00e7\u0131k\u0131\u015f sendromu tibbi terim olarak, hastal\u0131\u011f\u0131n nedenini de\u011fil, yerini (lokasyonunu &#8211; yani v\u00fccuttaki konumunu) tan\u0131mlayan bir ifadedir. Bu terim, karpal t\u00fcnel sendromu gibi di\u011fer sinir s\u0131k\u0131\u015fmas\u0131 hastal\u0131klar\u0131nda da ayn\u0131d\u0131r. Genel olarak, periferik sinir hastal\u0131klar\u0131nda durumlar\u0131 patoloji b\u00f6lgesine g\u00f6re s\u0131n\u0131fland\u0131rmak gelenekseldir. Ancak bu terim, sorunun nedeni hakk\u0131nda bilgi i\u00e7ermez. Bazen, s\u0131k\u0131\u015ft\u0131ran fakt\u00f6r g\u00f6r\u00fcnt\u00fclemede bariz \u015fekildie \u00e7\u0131kabilir (servikal aksesuar kaburga veya t\u00fcm\u00f6r). Ne yaz\u0131k ki, \u00e7o\u011fu zaman ileri g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri bile hastalarda te\u015fhis koymada yeterli de\u011filler.      <\/p>\n\n\n\n<p>Torasik \u00e7\u0131k\u0131\u015f sendromuna yatk\u0131nl\u0131k yaratan \u00e7e\u015fitli durumlar vard\u0131r. Mesela, kad\u0131nlar erkeklerden 3-4 kat daha fazla etkilenir. \u00c7al\u0131\u015fma \u015fekli tekrarlayan kol ve el hareketleri i\u00e7eren bireylerde TOS g\u00f6r\u00fclme oran\u0131 daha y\u00fcksek. K\u00f6t\u00fc v\u00fccut duru\u015fu, \u00f6zellikle de omuzlar\u0131n kambur durmas\u0131 s\u0131k\u0131\u015fmaya neden olabilir.    TOS hastal\u0131\u011f\u0131na yol a\u00e7an \u00e7e\u015fitli do\u011fumsal ve edinsel durumlar a\u015fa\u011f\u0131da \u00f6zetlenmi\u015ftir:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-cervical-accessory-rib\">Servikal aksesuar kaburga veya kosta<\/h3>\n\n\n\n<p>Normal insan v\u00fccudunda g\u00f6\u011f\u00fcs bo\u015flu\u011funu olu\u015fturan 12 \u00e7ift kaburga vard\u0131r. Nadiren, ki\u015filerde boyun b\u00f6lgesinik alt k\u0131sm\u0131nda aksesuar veya ekstra servikal kaburgalar (kostalar veya kotlar) olabilir. Yak\u0131n zamanda, geni\u015f literat\u00fcr taramas\u0131 \u00e7al\u0131\u015fmas\u0131, toplumun yakla\u015f\u0131k %1.1&#8217;inde boyunda (servikalde) kaburga bulundu\u011funu ortaya koymu\u015ftur.   <sup><a href=\"#footnote_1_2790\" id=\"identifier_1_2790\" class=\"footnote-link footnote-identifier-link\" title=\"Henry BM, Vikse J, Sanna B, et al. Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations. World Neurosurg. 2018;110:e965-e978. https:\/\/doi.org\/10.1016\/j.wneu.2017.11.148\">1<\/a><\/sup>  Ayr\u0131ca, TOS hastalar\u0131nda aksesuar servikal kaburga olu\u015fumu %29&#8217;dur &#8211; genel pop\u00fclasyona g\u00f6re yakla\u015f\u0131k 25 kat daha fazlad\u0131r. <sup><a href=\"#footnote_1_2790\" id=\"identifier_2_2790\" class=\"footnote-link footnote-identifier-link\" title=\"Henry BM, Vikse J, Sanna B, et al. Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations. World Neurosurg. 2018;110:e965-e978. https:\/\/doi.org\/10.1016\/j.wneu.2017.11.148\">1<\/a><\/sup>  <\/p>\n\n\n\n<p>Bu ekstra kaburgan\u0131n \u015fekli ve boyutu de\u011fi\u015fkenlik g\u00f6sterebilir &#8211; boyun omurunun yan kemik \u00e7\u0131k\u0131nt\u0131s\u0131n hafif\u00e7e b\u00fcy\u00fck olmas\u0131ndan neredeyse normal kaburgaya kadar. E\u011fer ekstra kaburga b\u00fcy\u00fckse, ucu genellikle 1. kaburgaya dokunur. R\u00f6ntgen net bir \u015fekilde servikal ek kaburgalar\u0131 g\u00f6sterir, ancak deneyimsiz bir g\u00f6z bunlar\u0131 fark edemeyebilir. <\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img decoding=\"async\" src=\"https:\/\/kamranaghayev.com\/wp-content\/uploads\/2024\/01\/Accessory-1st-rib-1.jpg\" alt=\"\" class=\"wp-image-2635\"\/><figcaption class=\"wp-element-caption\"><em>Sol tarafta aksesuar kaburga (oklar) varl\u0131\u011f\u0131n\u0131 g\u00f6steren r\u00f6ntgen g\u00f6r\u00fcnt\u00fcs\u00fc.<\/em><\/figcaption><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h-genetic-causes-of-anomalous-cervical-ribs\">Anormal servikal kaburgalar\u0131n genetik nedenleri<\/h4>\n\n\n\n<p>Ne yaz\u0131k ki, ek servikal kaburga (kot) olu\u015fumundan sorumlu mekanizma tam olarak bilinmemektedir, ancak HOX genlerindeki aksakl\u0131ktan kaynaklanabilece\u011fine dair kan\u0131tlar vard\u0131r. HOX veya homeobox genleri, v\u00fccut segmentasyonun d\u00fczg\u00fcn geli\u015fmesinden sorumlu olan genetik yap\u0131lard\u0131r. Bu genleri etkileyen bozukluklar ve mutasyonlar bir dizi omurga ve servikal kaburga anomalilerine yol a\u00e7ar. \u00c7al\u0131\u015fmalar, mutant HOX genlerine sahip farelerin yedinci servikal vertebrada ek kaburgalar geli\u015ftirdi\u011fini g\u00f6stermi\u015ftir. <sup><a href=\"#footnote_2_2790\" id=\"identifier_3_2790\" class=\"footnote-link footnote-identifier-link\" title=\"Horan GS, Wu K, Wolgemuth DJ, Behringer RR. Homeotic transformation of cervical vertebrae in Hoxa-4 mutant mice. Proc Natl Acad Sci U S A. 1994;91(26):12644-12648. https:\/\/doi.org\/10.1073\/pnas.91.26.12644\">2<\/a><\/sup>  \u0130lgin\u00e7 \u015fekilde, HOX genleri kanser geli\u015fiminde de rol oynamaktad\u0131r ve kanser hastalar\u0131nda HOX hipotezini destekleyen bilgiler var mesela ek kaburga olmas\u0131n\u0131n daha y\u00fcksek kanser riski ta\u015f\u0131d\u0131\u011f\u0131na ait yay\u0131nlar mevcut. <sup><a href=\"#footnote_3_2790\" id=\"identifier_4_2790\" class=\"footnote-link footnote-identifier-link\" title=\"Merks JH, Smets AM, Van Rijn RR, et al. Prevalence of rib anomalies in normal Caucasian children and childhood cancer patients. Eur J Med Genet. 2005;48(2):113-129. https:\/\/doi.org\/10.1016\/j.ejmg.2005.01.029\">3<\/a><\/sup>  <\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-first-rib-abnormalities\">1. kaburga anormallikleri<\/h3>\n\n\n\n<p>Birinci kaburga, birinci g\u00f6\u011f\u00fcs omuru ile sternum kemi\u011fi aras\u0131nda yerle\u015fen, kavisli, yass\u0131 bir kemiktir. Anormal, k\u0131r\u0131k veya yanl\u0131\u015f yerle\u015ftirilmi\u015f 1. kaburgalar, n\u00f6ro-vask\u00fcler demeti gerdirerek veya s\u0131k\u0131\u015ft\u0131rarak TOS&#8217;a neden olabilir. Kayna\u015fm\u0131\u015f kaburgalar veya \u00e7atal kaburgalar gibi do\u011fumsal anormallikler TOS&#8217;un iyi bilinen nedenleridir. Bir \u00e7al\u0131\u015fmada kal\u0131n 1. kaburgalar\u0131n TOS&#8217;a neden oldu\u011fu g\u00f6sterilmi\u015ftir. <sup><a href=\"#footnote_4_2790\" id=\"identifier_5_2790\" class=\"footnote-link footnote-identifier-link\" title=\"Chang CS, Chuang DC, Chin SC, Chang CJ. An investigation of the relationship between thoracic outlet syndrome and the dimensions of the first rib and clavicle. J Plast Reconstr Aesthet Surg. 2011;64(8):1000-1006 https:\/\/doi.org\/10.1016\/j.bjps.2011.03.017\">4<\/a><\/sup>  Ba\u015fka bir \u00e7al\u0131\u015fmada, birinci kaburgan\u0131n sternal ucuna yak\u0131n anormal kemik \u00e7\u0131k\u0131nt\u0131s\u0131n\u0131n ven\u00f6z TOS geli\u015fiminden sorumlu oldu\u011fu bulunmu\u015ftur. <sup><a href=\"#footnote_5_2790\" id=\"identifier_6_2790\" class=\"footnote-link footnote-identifier-link\" title=\"Gharagozloo F, Meyer M, Tempesta B, Strother E, Margolis M, Neville R. Proposed pathogenesis of Paget-Schroetter disease: impingement of the subclavian vein by a congenitally malformed bony tubercle on the first rib. J Clin Pathol. 2012;65(3):262-266 https:\/\/dx.doi.org\/10.1136\/jclinpath-2011-200479\">5<\/a><\/sup> <\/p>\n\n\n\n<p>Travma da TOS&#8217;a \u00f6nemli bir katk\u0131da bulunur. K\u0131r\u0131lan ilk kaburgalar uygun \u015fekilde iyile\u015fmeyebilir. Sonu\u00e7 olarak, k\u0131r\u0131k b\u00f6lgesinde ya a\u015f\u0131r\u0131 kemik nas\u0131r olu\u015fumu ya da ps\u00f6doartroz (t\u00fcm\u00f6r benzeri \u015fi\u015fli\u011fe yol a\u00e7an kemik kaynama eksikli\u011fi) geli\u015febilir. B\u00f6ylece yanl\u0131\u015f \u015fekilde iyile\u015fmi\u015f 1. kaburgalar torasik \u00e7\u0131k\u0131\u015f sendromuna da neden olabilir. Hemanjiyomlar gibi iyi huylu lezyonlar da dahil olmak \u00fczere birinci kaburgan\u0131n t\u00fcm\u00f6rleri kemi\u011fi bombele\u015ftiri ve yak\u0131ndaki n\u00f6ro-vask\u00fcler demeti s\u0131k\u0131\u015ft\u0131r\u0131r. <\/p>\n\n\n\n<p>Boyun kaburgalar\u0131nda oldu\u011fu gibi r\u00f6ntgen 1. kaburga anormalliklerini te\u015fhis edebilir. Bununla birlikte, birinci kaburgan\u0131n karma\u015f\u0131k anatomisi, \u00fcst \u00fcste binen kom\u015fu kemikler ve \u00e7e\u015fitli birinci kaburga patolojileri, deneyimsiz biririsi i\u00e7in te\u015fhisi zorla\u015ft\u0131r\u0131r. Bu nedenle, yaln\u0131zca engin deneyime sahip uzmanlar r\u00f6ntgen filmlerinde birinci kaburga anormalliklerini do\u011fru bir \u015fekilde tespit edebilir. 3D rekonstr\u00fcksiyonlu BT, 1. kaburgalar\u0131 r\u00f6ntgenden \u00e7ok daha iyi ortaya koyabilir ve kemik anormallikleri s\u00f6z konusu oldu\u011funda m\u00fckemmel bir g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemidir. <\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-fibromuscular-soft-tissue-bands\">Fibrom\u00fcsk\u00fcler yumu\u015fak doku bantlar\u0131<\/h3>\n\n\n\n<p>Fibromusk\u00fcler yumu\u015fak doku bantlar\u0131 TOS vakalar\u0131n\u0131n \u00f6nemli bir k\u0131sm\u0131n\u0131 olu\u015fturmaktad\u0131r. Nadiren de olsa, s\u0131k\u0131\u015fman\u0131n nedeni anormal adale, fibr\u00f6z bant veya ikisinin kombinasyonu olabilir. \u00d6rne\u011fin, skalenus<em>antikus, skalenus minimus<\/em> ve <em>subklavius postikus<\/em> gibi anormal kaslar n\u00f6ro-vaks\u00fcler kompresyona neden olabilir, lakin bunlar nispeten nadirdir. Bu fibro-m\u00fcsk\u00fcler doku bantlar\u0131 omurgan\u0131n \u00e7e\u015fitli yerlerinden (genellikle C7 transvers prosesinden) birinci kaburgaya kadar uzanarak n\u00f6ro-vask\u00fcler demeti gerer ve s\u0131k\u0131\u015ft\u0131r\u0131r. <sup><a href=\"#footnote_6_2790\" id=\"identifier_7_2790\" 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\">6<\/a><\/sup>   <\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-hypertrophic-muscles\">Hipertrofik adaleler <\/h3>\n\n\n\n<p>Hipertrofik kaslar n\u00f6ro-vask\u00fcler kompresyona neden olabilir. Kollar\u0131n\u0131 ve ellerini i\u015f ve spor i\u00e7in yo\u011fun olarak kullanan ki\u015filer bu mekanizma ile geli\u015fen TOS&#8217;a \u00f6zellikle yatk\u0131nd\u0131r. Do\u011fal olarak, sporcularda s\u0131kl\u0131kla TOS geli\u015fir. Skalen kas hipertrofisi genellikle n- ve a-TOS ile sonu\u00e7lan\u0131r (hem arter hem de brakiyal pleksus skalen \u00fc\u00e7genin i\u00e7inden ge\u00e7ti\u011fi i\u00e7in). <sup><a href=\"#footnote_7_2790\" id=\"identifier_8_2790\" class=\"footnote-link footnote-identifier-link\" title=\"Qaja E, Honari S, Rhee R. Arterial thoracic outlet syndrome secondary to hypertrophy of the anterior scalene muscle. J Surg Case Rep. 2017;2017(8):rjx158. https:\/\/doi.org\/10.1093\/jscr\/rjx158\">7<\/a><\/sup> Sublklavius kas\u0131 hipertrofisi ise subklavyen venin s\u0131k\u0131\u015fmas\u0131na ve hatta trombozuna (Paget-Schroetter hastal\u0131\u011f\u0131) neden olabilir.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-costo-clavicular-compression\">Kosto-klavik\u00fcler kompresyon<\/h3>\n\n\n\n<p>Hem k\u00f6pr\u00fcc\u00fck kemi\u011fi hem de birinci kaburga sternumun \u00fcst-kenar k\u00f6\u015fesi ila ile eklem yapar. Birinci kaburgan\u0131n hareket kabiliyeti azd\u0131r, oysa k\u00f6pr\u00fcc\u00fck kemi\u011fi (k\u00f6pr\u00fcc\u00fck kemi\u011fi) \u00e7ok hareketlidir. Klavikulan\u0131n di\u011fer ucu, skapula kemi\u011fi ile ba\u015fka bir eklem yapar. Temel olarak klavikula sabit sternum ve hareketli skapula aras\u0131nda bir kald\u0131ra\u00e7t\u0131r. Normalde klavikula kemi\u011fi ile birinci kaburga aras\u0131ndaki alan &#8211; kosto-klavik\u00fcler bo\u015fluk yeterince geni\u015ftir. N\u00f6rovask\u00fcler demet bu bo\u015fluktan yani birinci kaburgan\u0131n \u00fcst\u00fcnden ve klavikulan\u0131n alt\u0131ndan ge\u00e7er. Bununla birlikte, kol abd\u00fcksiyonu ile kosto-klavik\u00fcler aral\u0131k skapulan\u0131n hareketine ba\u011fl\u0131 olarak iyice daralabilir. Bu etki &#8220;f\u0131nd\u0131kk\u0131ran mekanizmas\u0131&#8221; olarak bilinir ve kosto-klavik\u00fcler mesafeyi ileri derecede daraltabilir. Ara\u015ft\u0131rmalar, normal insanlarda mesafenin yeterince geni\u015f kald\u0131\u011f\u0131n\u0131 ve b\u00f6ylece sinirler ve damarlar \u00fczerinde bask\u0131 olmad\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. TOS hastalar\u0131nda bu aral\u0131k kritik derecede daral\u0131r ve n\u00f6ro-vask\u00fcler kompresyona neden olur. <sup><a href=\"#footnote_8_2790\" id=\"identifier_9_2790\" class=\"footnote-link footnote-identifier-link\" title=\"Illig KA, Doyle AJ. A comprehensive review of Paget-Schroetter syndrome. J Vasc Surg. 2010;51(6):1538-1547. https:\/\/doi.org\/10.1016\/j.jvs.2009.12.022\">8<\/a><\/sup>  <\/p>\n\n\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-2-e1741017510429.jpeg\" alt=\"\" class=\"wp-image-2639\" style=\"width:378px;height:auto\"\/><figcaption class=\"wp-element-caption\"><em>Kollar yukar\u0131da \u00e7ekilen ve klavikula ile birinci kaburga aras\u0131nda brakiyal pleksus s\u0131k\u0131\u015fmas\u0131n\u0131 g\u00f6steren \u00f6rnek MR g\u00f6r\u00fcnt\u00fcs\u00fc<\/em>.<\/figcaption><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-blood-vessels\">Kan damarlar\u0131<\/h3>\n\n\n\n<p>Bazen subklavyen damarlardan dallanan kan damarlar\u0131 brakiyal pleksus etraf\u0131nda d\u00f6nerek bas\u0131ya neden olabilir. Bu k\u00fc\u00e7\u00fck damar nedenlerinin radyolojik olarak te\u015fhis edilmesi \u00e7ok zordur ve genellikle ameliyat s\u0131ras\u0131nda ke\u015ffedilir. <sup><a href=\"#footnote_9_2790\" id=\"identifier_10_2790\" class=\"footnote-link footnote-identifier-link\" title=\"Hanna A, Bodden LO, Siebiger GRL. Neurogenic Thoracic Outlet Syndrome Caused by Vascular Compression of the Brachial Plexus: A Report of Two Cases. J Brachial Plex Peripher Nerve Inj. 2018;13(1):e1-e3. https:\/\/doi.org\/10.1055\/s-0037-1607977\">9<\/a><\/sup>  <\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-chronic-kidney-disease-and-dialysis\">Kronik b\u00f6brek hastal\u0131\u011f\u0131 ve diyaliz<\/h3>\n\n\n\n<p>Arterio-ven\u00f6z fist\u00fcl hemodiyaliz hastalar\u0131nda kolay damar eri\u015fimi sa\u011flar. Ancak bu kolay damar ula\u015f\u0131m\u0131n major komplikasyonu var &#8211; subklavyen vende kan ak\u0131\u015f\u0131n\u0131n ve t\u00fcrb\u00fclans\u0131n artmas\u0131d\u0131r. Bu durum ana ven\u00f6z daralmaya yol a\u00e7ar ve torasik \u00e7\u0131k\u0131\u015f b\u00f6lgesi \u00f6zellikle hassas bir b\u00f6lgedir. \u00c7o\u011fu vTOS vakas\u0131nda oldu\u011fu gibi, bu darl\u0131k genellikle klavikula ile birinci kaburga aras\u0131ndaki &#8220;f\u0131nd\u0131kk\u0131ran etkisi&#8221; nedeniyle kosto-klavik\u00fcler (veya ven\u00f6z) \u00fc\u00e7gende geli\u015fir. <sup><a href=\"#footnote_10_2790\" id=\"identifier_11_2790\" class=\"footnote-link footnote-identifier-link\" title=\"Davies MG, Hart JP. Venous thoracic outlet syndrome and hemodialysis. Front Surg. 2023;10:1149644. https:\/\/doi.org\/10.3389\/fsurg.2023.1149644\">10<\/a><\/sup>  <\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-next-thoracic-outlet-syndrome-signs-and-symptoms\">Sonraki: <a href=\"https:\/\/kamranaghayev.com\/tr\/torasik-outlet-sendromu-belirtiler-riskleri\/\">Torasik Outlet Sendromu Belirti ve Semptomlar\u0131<\/a><\/h2>\n\n\n\n<p><\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-references\">Referanslar<\/h2>\n<ol class=\"footnotes\"><li id=\"footnote_1_2790\" class=\"footnote\">Henry BM, Vikse J, Sanna B, et al. Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations. <em>World Neurosurg. <\/em>2018;110:e965-e978. <a href=\"https:\/\/doi.org\/10.1016\/j.wneu.2017.11.148\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/j.wneu.2017.11.148<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_1_2790\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_2_2790\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_2_2790\" class=\"footnote\">Horan GS, Wu K, Wolgemuth DJ, Behringer RR. Homeotic transformation of cervical vertebrae in Hoxa-4 mutant mice. <em>Proc Natl Acad Sci U S A. <\/em>1994;91(26):12644-12648. <a href=\"\">https:\/\/doi.org\/10.1073\/pnas.91.26.12644<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_3_2790\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_3_2790\" class=\"footnote\">Merks JH, Smets AM, Van Rijn RR, et al. Prevalence of rib anomalies in normal Caucasian children and childhood cancer patients. <em>Eur J Med Genet. <\/em>2005;48(2):113-129. <a href=\"\">https:\/\/doi.org\/10.1016\/j.ejmg.2005.01.029<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_4_2790\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_4_2790\" class=\"footnote\">Chang CS, Chuang DC, Chin SC, Chang CJ. An investigation of the relationship between thoracic outlet syndrome and the dimensions of the first rib and clavicle. <em>J Plast Reconstr Aesthet Surg. <\/em>2011;64(8):1000-1006 <a href=\"\">https:\/\/doi.org\/10.1016\/j.bjps.2011.03.017<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_5_2790\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_5_2790\" class=\"footnote\">Gharagozloo F, Meyer M, Tempesta B, Strother E, Margolis M, Neville R. Proposed pathogenesis of Paget-Schroetter disease: impingement of the subclavian vein by a congenitally malformed bony tubercle on the first rib. <em>J Clin Pathol. <\/em>2012;65(3):262-266 <a href=\"https:\/\/dx.doi.org\/10.1136\/jclinpath-2011-200479\" target=\"_blank\" rel=\"noopener\">https:\/\/dx.doi.org\/10.1136\/jclinpath-2011-200479<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_6_2790\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_6_2790\" 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<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_7_2790\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_7_2790\" class=\"footnote\">Qaja E, Honari S, Rhee R. Arterial thoracic outlet syndrome secondary to hypertrophy of the anterior scalene muscle. <em>J Surg Case Rep. <\/em>2017;2017(8):rjx158. <a href=\"https:\/\/doi.org\/10.1093\/jscr\/rjx158\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1093\/jscr\/rjx158<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_8_2790\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_8_2790\" class=\"footnote\">Illig KA, Doyle AJ. A comprehensive review of Paget-Schroetter syndrome. <em>J Vasc Surg. <\/em>2010;51(6):1538-1547. <a href=\"\">https:\/\/doi.org\/10.1016\/j.jvs.2009.12.022<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_9_2790\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_9_2790\" class=\"footnote\">Hanna A, Bodden LO, Siebiger GRL. Neurogenic Thoracic Outlet Syndrome Caused by Vascular Compression of the Brachial Plexus: A Report of Two Cases. <em>J Brachial Plex Peripher Nerve Inj. <\/em>2018;13(1):e1-e3. <a href=\"\">https:\/\/doi.org\/10.1055\/s-0037-1607977<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_10_2790\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_10_2790\" class=\"footnote\">Davies MG, Hart JP. Venous thoracic outlet syndrome and hemodialysis. <em>Front Surg. <\/em>2023;10:1149644. <a href=\"\">https:\/\/doi.org\/10.3389\/fsurg.2023.1149644<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_11_2790\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>Torasik \u00e7\u0131k\u0131\u015f sendromuna genel bak\u0131\u015f: ne oldu\u011funu, nas\u0131l geli\u015fti\u011fini ve kimlerin risk alt\u0131nda olabilece\u011fini detayl\u0131 a\u00e7\u0131klamas\u0131.<\/p>\n","protected":false},"author":2,"featured_media":4017,"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-2790","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\/2790","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=2790"}],"version-history":[{"count":0,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/posts\/2790\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/media\/4017"}],"wp:attachment":[{"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/media?parent=2790"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/categories?post=2790"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/tags?post=2790"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}