{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T07:33:05Z","timestamp":1770881585843,"version":"3.50.1"},"reference-count":37,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T00:00:00Z","timestamp":1666310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Education and Sciences in Poland","award":["SKN\/SP\/495844\/2021"],"award-info":[{"award-number":["SKN\/SP\/495844\/2021"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>A thoracic outlet syndrome (TOS) is the type of brachial plexus disorder most difficult to objectively assess using a clinical examination and differential diagnosis. Its symptoms can be frequently misdiagnosed, especially among others with cervical disc-root conflicts, plexopathies, and peripheral neuropathies. In this study, we aim to identify the correlations between positive Doppler ultrasonography results indicating pathological changes in the subclavian flow velocity, clinical tests, and chosen clinical neurophysiology recordings as proposed alternative or supplementary diagnostic tools for evaluating TOS patients. Sixty TOS patients with positive Doppler ultrasonography and Roos test results and sixty healthy people as a control group were bilaterally examined, and the results were compared. Pain intensity was assessed using a visual analogue scale (VAS). Sensory perceptions within C4\u2013C8 dermatomes were assessed with Von Frey filament (FvF) tests. The activity of motor units in the proximal and distal muscles of the upper extremities was evaluated using surface electromyography (sEMG) during maximal contractions before and after a provocative raised hands test (RHT). An electroneurography (ENG) was used to evaluate the transmission of nerve impulses peripherally. Motor evoked potential (MEP) recordings, induced by the over-vertebral magnetic stimulation of the C5\u2013C7 neuromeres, were used to examine motor transmissions from the cervical motor centres to the upper extremities muscles. The results revealed a relationship between positive Doppler test scores and pathological changes in the subclavian flow velocity through the results of the following diagnostic tools: a VAS score of 1.9 was detected on average, superficial sensory perception abnormalities were found in the innervation areas of the ulnar nerves detected by FvF tests, a decrease in the amplitudes of sEMG recordings was seen in distal rather than proximal muscles (especially following the RHT), a decrease in the motor and sensory peripheral transmissions of nerve impulses in the median, ulnar and cutaneous anterobrachial median nerves was seen, as well as MEP amplitudes recorded from the abductor pollicis brevis muscle. The provocative RHT combined with sEMG and MEP recordings can be considered accurate and objective clinical neurophysiology tools that could supplement the commonly used clinical tests. Such an approach may result in a more precise neurogenic TOS diagnostic algorithm.<\/jats:p>","DOI":"10.3390\/bioengineering9100598","type":"journal-article","created":{"date-parts":[[2022,10,23]],"date-time":"2022-10-23T20:43:50Z","timestamp":1666557830000},"page":"598","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Relationships between the Clinical Test Results and Neurophysiological Findings in Patients with Thoracic Outlet Syndrome"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1614-0644","authenticated-orcid":false,"given":"Agata Maria","family":"Kaczmarek","sequence":"first","affiliation":[{"name":"Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, 28 Czerwca 1956 No 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8671-0497","authenticated-orcid":false,"given":"Juliusz","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, 28 Czerwca 1956 No 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6421-7909","authenticated-orcid":false,"given":"Katarzyna","family":"Leszczy\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, 28 Czerwca 1956 No 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulina","family":"Wietrzak","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, 28 Czerwca 1956 No 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna","family":"Kaczmarek","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, 28 Czerwca 1956 No 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/S0749-0712(03)00092-1","article-title":"Current trends in treatment of thoracic outlet syndrome","volume":"20","author":"Leinberry","year":"2004","journal-title":"Hand Clin."},{"key":"ref_2","first-page":"353","article-title":"Thoracic outlet syndrome","volume":"29","author":"Parziale","year":"2000","journal-title":"Am. J. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Povlsen, S., and Povlsen, B. (2018). Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions. Diagnostics, 8.","DOI":"10.3390\/diagnostics8010021"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Li, N., Dierks, G., Vervaeke, H., Jumonville, A., Kaye, A., Myrcik, D., Paladini, A., Varrassi, G., Viswanath, O., and Urits, I. (2021). Thoracic Outlet Syndrome: A Narrative Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10050962"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/2054270420983101","article-title":"Duplex ultrasound in the evaluation of venous and arterial thoracic outlet syndrome","volume":"12","author":"Hu","year":"2021","journal-title":"JRSM Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.jvs.2007.04.050","article-title":"Diagnosis of thoracic outlet syndrome","volume":"46","author":"Sanders","year":"2007","journal-title":"J. Vasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.thromres.2005.05.029","article-title":"The post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: A systematic review","volume":"117","author":"Elman","year":"2006","journal-title":"Thromb. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1161\/01.CIR.0000142289.94369.D7","article-title":"Upper-extremity deep vein thrombosis: A prospective registry of 592 patients","volume":"110","author":"Joffe","year":"2004","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/NRL.0b013e318176b98d","article-title":"Thoracic outlet syndrome: A review","volume":"14","author":"Sanders","year":"2008","journal-title":"Neurologist"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/S0266-7681(03)00010-X","article-title":"Compression and stretching of the brachial plexus in thoracic outlet syndrome: Correlation between neuroradiographic findings and symptoms and signs produced by provocation manoeuvres","volume":"28","author":"Ide","year":"2003","journal-title":"J. Hand Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"136","DOI":"10.3389\/fphys.2019.00136","article-title":"Microvascular Response to the Roos Test Has Excellent Feasibility and Good Reliability in Patients with Suspected Thoracic Outlet Syndrome","volume":"10","author":"Henni","year":"2019","journal-title":"Front. Physiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1186\/2047-783X-14-10-443","article-title":"Thoracic outlet syndrome: Do we have clinical tests as predictors for the outcome after surgery?","volume":"14","author":"Ozimek","year":"2009","journal-title":"Eur. J. Med. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/S1297-319X(01)00298-6","article-title":"Diagnosing thoracic outlet syndrome: Contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients","volume":"68","author":"Gillard","year":"2001","journal-title":"Jt. Bone Spine"},{"key":"ref_14","first-page":"67","article-title":"False positive rate of thoracic outlet syn-drome diagnostic maneuvers","volume":"48","author":"Nord","year":"2008","journal-title":"Electromyogr. Clin. Neurophysiol."},{"key":"ref_15","first-page":"253","article-title":"Electrophysiological assessment in neurogenic thoracic outlet syndrome","volume":"41","author":"Arpa","year":"2001","journal-title":"Electromyogr. Clin. Neurophysiol."},{"key":"ref_16","first-page":"1429","article-title":"Thoracic outlet syndrome","volume":"66","author":"Sonoo","year":"2014","journal-title":"Brain Nerve"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0749-0712(03)00089-1","article-title":"\u201cEMG\u201d for thoracic outlet syndrome","volume":"20","author":"Tolson","year":"2004","journal-title":"Hand Clin."},{"key":"ref_18","first-page":"149","article-title":"Sensory and motor evoked potentials findings in patients with thoracic outlet syn-drome","volume":"45","author":"Haghighi","year":"2005","journal-title":"Electromyogr. Clin. Neurophysiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1002\/(SICI)1097-4598(199805)21:5<647::AID-MUS13>3.0.CO;2-S","article-title":"Medial antebrachial cutaneous sensory studies in the evaluation of neurogenic thoracic outlet syndrome","volume":"21","author":"Do","year":"1998","journal-title":"Muscle Nerve"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.avsg.2007.09.009","article-title":"Medial Antebrachial Cutaneous Nerve Measurements to Diagnose Neurogenic Thoracic Outlet Syndrome","volume":"22","author":"Machanic","year":"2008","journal-title":"Ann. Vasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.clinph.2010.06.025","article-title":"Current status on electrodiagnostic standards and guidelines in neuromuscular disorders","volume":"122","author":"Pugdahl","year":"2011","journal-title":"Clin. Neurophysiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1016\/j.clinph.2019.05.008","article-title":"Standards for quantification of EMG and neurography","volume":"130","author":"Falck","year":"2019","journal-title":"Clin. Neurophysiol."},{"key":"ref_23","first-page":"323","article-title":"Diagnostic utility of somatosensory and motor evoked potentials in a patient with thoracic outlet syndrome","volume":"43","author":"Haghighi","year":"2003","journal-title":"Electromyogr. Clin. Neurophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1002\/mus.27395","article-title":"Variability in electrodiagnostic findings associated with neurogenic thoracic outlet syndrome","volume":"65","author":"Mul","year":"2021","journal-title":"Muscle Nerve"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/S1042-3680(18)30055-X","article-title":"Diagnosis and Treatment of Thoracic Outlet Syndrome","volume":"12","author":"Sheth","year":"2001","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s002680020079","article-title":"Treatment of Thoracic Outlet Syndrome: Long-term Results","volume":"25","author":"Athanassiadi","year":"2001","journal-title":"World J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1179\/106698110X12640740712734","article-title":"Thoracic outlet syndrome: A controversial clinical condition. Part 1: Anatomy, and clinical examination\/diagnosis","volume":"18","author":"Hooper","year":"2010","journal-title":"J. Man. Manip. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"623","DOI":"10.2214\/ajr.158.3.1739007","article-title":"Thoracic outlet syndrome: Evaluation of the subclavian vessels by color duplex sonography","volume":"158","author":"Longley","year":"1992","journal-title":"Am. J. Roentgenol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"795","DOI":"10.7863\/jum.2001.20.7.795","article-title":"Color Doppler and duplex sonography in 5 patients with thoracic outlet syndrome","volume":"20","author":"Wadhwani","year":"2001","journal-title":"J. Ultrasound Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/j.jhsa.2011.04.009","article-title":"Semmes-Weinstein mono-filaments: Influence of temperature, humidity and age","volume":"36","author":"Haloua","year":"2011","journal-title":"J. Hand Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/BRS.0000000000001691","article-title":"Evolution of Muscles Dysfunction From Myofascial Pain Syndrome Through Cervical Disc-Root Conflict to Degenerative Spine Disease","volume":"42","author":"Huber","year":"2017","journal-title":"Spine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"154","DOI":"10.2106\/00004623-199802000-00002","article-title":"Validity of Observer-Based Aggregate Scoring Systems as Descriptors of Elbow Pain, Function, and Disability*","volume":"80","author":"Turchin","year":"1998","journal-title":"J. Bone Jt. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bryndal, A., Wojtysiak, M., Moskal, J., Lipiec-Kowalska, J., Borowczyk, M., Ta\u0144ska, M., Grochulska, A., Huber, J., and Majchrzycki, M. (2019). Motor Evoked Potentials after Supraspinal Stimulation in Pre- and Postoperative Evaluations of Patients with Cervical Radiculopathy. BioMed Res. Int., 4576493.","DOI":"10.1155\/2019\/4576493"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Wincek, A., Huber, J., Leszczy\u0144ska, K., Fortuna, W., Okurowski, S., Chmielak, K., and Tabakow, P. (2021). The Long-Term Effect of Treatment Using the Transcranial Magnetic Stimulation rTMS in Patients after Incomplete Cervical or Thoracic Spinal Cord Injury. J. Clin. Med., 10.","DOI":"10.3390\/jcm10132975"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Huber, J., Leszczy\u0144ska, K., Wincek, A., Szymankiewicz-Szuka\u0142a, A., Fortuna, W., Okurowski, S., and Tabakow, P. (2021). The Role of Pe-ripheral Nerve Electrotherapy in Functional Recovery of Muscle Motor Units in Patients after Incomplete Spinal Cord Injury. Appl. Sci., 11.","DOI":"10.3390\/app11209764"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Kaczmarek, K., Huber, J., Leszczy\u0144ska, K., and Daroszewski, P. (2022). Electroneurographic Evaluation of Neural Impulse Transmission in Patients after Ischemic Stroke Following Functional Electrical Stimulation of Antagonistic Muscles at Wrist and Ankle in Two-Month Follow-Up. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19020713"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.avsg.2021.03.051","article-title":"Diagnosis of Neurogenic Thoracic Outlet Syndrome Based on the Clinical Status","volume":"76","author":"Hwang","year":"2021","journal-title":"Ann. Vasc. Surg."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/9\/10\/598\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:00:30Z","timestamp":1760144430000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/9\/10\/598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,21]]},"references-count":37,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["bioengineering9100598"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering9100598","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,21]]}}}