title: The radiologic relationship of the shoulder girdle to the thorax as an aid in diagnosing neurogenic thoracic outlet syndrome.
abstract: OBJECTIVE
  Neurogenic thoracic outlet syndrome (NTOS) is produced by compression of the brachial plexus in the thoracic outlet. The lower position of the shoulder girdle relative to the upper thorax may be related to NTOS. We investigated this hypothesis using plain cervical radiographs.
  
  
  METHODS
  We conducted this case-control study using plain cervical anteroposterior and lateral radiographs in 63 NTOS patients and 126 carpal tunnel syndrome patients who were matched for age and sex. To estimate the position of the shoulder girdle relative to the upper thorax, we analyzed the level of the clavicle using 2 parameters: the number of vertebrae visible in a lateral radiograph and the number of vertebrae above the line connecting both sternal ends of the clavicles in an anteroposterior radiograph. The number of vertebrae visible in a lateral radiograph was the parameter for the level of the lateral part of the clavicle relative to the upper thorax, whereas we used the number of vertebrae above the line connecting both sternal ends of the clavicles in an anteroposterior radiograph to determine the level of the medial part of the clavicle.
  
  
  RESULTS
  Both parameters were greater in the NTOS group than in the control group, which suggests that the level of the shoulder girdle was lower in the NTOS group than in the control group. In addition, the risk of NTOS was increased in patients with lower shoulder girdle position.
  
  
  CONCLUSIONS
  The lower placement of the shoulder girdle relative to the upper thorax was related to NTOS. Physicians may be able to estimate the position of the shoulder girdle using plain cervical radiographs when NTOS is clinically suspected.
  
  
  METHODS
  Diagnostic IV.
authors.affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Cho
authors.forename: Hyuk Jin
authors.initials: HJ
authors.lastname: Lee
authors.forename: Hyun Sik
authors.initials: HS
authors.lastname: Gong
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Rhee
authors.forename: Sang Jae
authors.initials: SJ
authors.lastname: Park
authors.forename: Goo Hyun
authors.initials: GH
authors.lastname: Baek
mesh_terms: D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging / Q000601:surgery; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012782:Shoulder / Q000473:pathology*; D018709:Statistics, Nonparametric; D013901:Thoracic Outlet Syndrome / Q000000981:diagnostic imaging*