RESUMO
Thoracic outlet syndrome (TOS) is a blanket term encapsulating many different clinical entities. Neurologic or neurogenic TOS (NTOS) is its main contributor, but it remains a complicated and sometimes controversial entity. NTOS incorporates numerous types, etiologies, clinical presentations, diagnostic findings, and therapeutic modalities. This article reviews the spectrum of disease within the thoracic outlet that affects the brachial plexus, with a special emphasis on the commonly afflicted sports medicine patient.
Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Medicina Esportiva/tendências , Síndrome do Desfiladeiro Torácico/diagnóstico , Síndrome do Desfiladeiro Torácico/terapia , Traumatismos em Atletas/epidemiologia , Plexo Braquial/patologia , Humanos , Medicina Esportiva/métodos , Síndrome do Desfiladeiro Torácico/epidemiologiaRESUMO
The original rationale for viscosupplementation with hyaluronans was fluid replacement, suggesting that the most viscous materials (eg, those of highest molecular weight [MW]) would provide the most clinical benefits. However, it has become clear that mechanisms of action for osteoarthritis pain management are not only mechanical but also biological. After intra-articular injection, hyaluronans exert a range of biological actions within the joint. Although high- and low- to mid-MW hyaluronans (but not hyaluronans <500 kDa MW) are more or less active (depending on the specific effect examined), it is not known which actions are clinically meaningful. There is no evidence for a difference between hyaluronan products in clinical efficacy measured as pain relief, but investigators in several preclinical studies evaluating joint-structure modification in osteoarthritis models have reported advantages to using low- to mid-MW hyaluronans.
