I was taken back to the very best of the anatomy presentations I had as a medical student coupling that with the latest and greatest of grand rounds presentations. Following that were a question and answer series mostly directed by lawyers.
I knew the anatomy and pathology. I knew the diagnosis. I even knew the general information about treatment though was impressed to get the very latest and even the still controversial aspects of cutting edge management. What I wouldn't have got at medical school or in grand rounds was the lawyers questions. How does this condition apply to a patient with a disability claim. What is the claim and counter claim to the presentation. Now that's where the doctors answers were most interesting. It was a bit of a snapshot of a trial really and the doctors did a marvellous job of responding and making their responses understandable to all and sundry. No wonder they are considered the best in their field.
Further I've seen 2 cases this last year myself. I'm going to review both because I thought one specifically was carpal tunnel syndrome but when everything came back negative I suggested we take a wait and see attitude. I confess I wish I and the fellows family physician had heard both these presentations because I think there is more I can offer thanks to these fine gentlemen.
These are my notes. The Trial Lawyers Association of British Columbia provided a cd with alot of the papers and presentations. There was so much information being presented that with both doctors I only gleaned highlights. Further a lot more was on the slides and finally I was only selecting out the bits and pieces of these talks that pertained specifically to my concerns. That said, I think sharing them gives a person a glimpse into the wealth of information these two gentleman presented. I would strongly recommend anyone with similiar concerns contact them. In sharing these notes I'm as interested in sharing the level of erudition and discussion that goes on at these conferences.
- all of them can be compressed
- patients can present with ischemic hand
- Investigation and see if we can do bypass
- Venous (5-15%
- cervical rib syndrome
- 1861 Coote Cervical rib resection
- 1895 Advent of radiography
- 1916 -100 cases of cervical rib syndrome reported
- early 1900’s focus to other structures
- 1935 Scalenus anticus syndrome
- 1943 compression between clavicle and first rib
- 1956 ‘thoracic outlet syndrome
- 4 large ‘cadaver’ studies - anatomic variance between 35 and 60%
- 8 types
- scaring noticed o
- direct trauma - fracture of rib or clavicule - can have immediate numbness
- follow up showed benefit took 23 months physical and mental 10 months
- disputed - we know it exists but can’t prove it
- Only 10% of bilateral ‘normal’ anatomy
- arm and hand
- upper neck and some of face
- looking for reproduction of signs and symptons
- helps to decide if surgery will help
- if numbness beyond wrist unusual and therefore usually thoracic outlet
- studies - 65-100 % treatment (typical 65-80%)
- but all have all kinds of problems of randomization
- nutritional counselling
- exercise program - stretching scalene