Thoracic Outlet Syndrome Essay Example | Topics and Well Written Essays - 1250 words

Thoracic Outlet Syndrome - Essay Example All should be familiar with the presenting signs and symptoms of TOS, and include the syndrome in their differential diagnosis. TOS typically presents with aching-type pain radiating from the scapula down the upper extremity, with associated numbness or tingling. It is common in women between 20 and 50 years of age TOS is usually divided into three groups: vascular TOS, in those with compression of the subclavian vessels; neurogenic TOS, those with compression of the brachial plexus; and disputed neurogenic TOS (Roos, 1984). The diagnosis of TOS can be made by history, clinical examination, provocative tests, ultrasound, vascular studies, radiological evaluation, and electrodiagnostic evaluation. Initially, conservative treatment is offered to most patients. Definitive treatment involves surgical decompression of the related structures (Roos, 1984) TOS subcategories usually are caused by the compression of brachial plexus elements and/or vasculature, which occurs in what is called thoracic outlet (TO), but really is the thoracic "inlet." The compressive sites within this anatomic territory vary and include the interscalene triangle, the most common location, and the costoclavicular and subcoracoid spaces. The TO, more correctly termed thoracic inlet, is a pyramidal space bordered anteriorly by (1) the claviculomanubrial complex, laterally by (2) the first rib and posteriorly by (3) the vertebral column (Roos, 1984). Contained in this space are the apex of the lung and pleura, the subclavian artery and veins and jugular vein, the lymphatics, the anterior and middle scalene muscles, the brachial plexus trunks and the sympathetic trunk. The thoracic inlet region can be subdivided into 3 anatomic spaces, each of which can be the site of compression of the structures therein. The spaces and their associated compression syndromes in clude: the proximal (1) interscalene triangle, associated with the "scalenus anticus syndrome," a TOS without a bony abnormality and due to compression of the brachial plexus and/or vasculature between hypertrophied anterior and middle scalene muscles. There is also, next, the (2) costoclavicular triangle or space, resulting in the costoclavicular syndrome, owing to narrowing of the space between the clavicle and first rib, and the (3) subcoracoid space. The subclavian vessels and brachial plexus traverse these 3 anatomic spaces within the cervico-axillary canal before reaching the arm (Divi etal, 2005). Vascular TOS These can be arterial or venous. Arterial TOS results from subclavian artery compression and insufficiency, which manifests as intermittent arm and/or hand coolness and fatigue. Actual arterial damage can occur and result in an aneurysm, embolus, and/or vessel occlusion with accompanying advanced ischemia, or even gangrene. Venous TOS is another form of vascular TOS presenting as intermittent mild arm swelling and duskiness from subclavian vein compression owing to bony anomalies or fascial bands at the level of the thoracic inlet (Divi etal, 200). These mild findings can progress to constant pain and severe upper extremity edema with skin discoloration. A pulmonary embolus from subclavian vein injury and thrombosis may ultimately occur (Roos, 1984) Investigation for vascular TOS In the radiologic evaluation of a patient with possible TOS, chest x-rays may reveal

The Lamentation by Ludovicco Carracci Research Paper

The Lamentation by Ludovicco Carracci - Research Paper Example The figure’s pose invokes the dead Christ. It shows Christ’s right hand as being distorted. His left hand which is cradled by Mary Magdalene appears dislocated. The virgin has fainted at the sight of her son lying across her lap. In this artwork, the Virgin Mary is shown as a middle-aged woman instead of young and beautiful. Saint John is shielding Christ’s feet by a raised winding sheet and falls with increasing strength on his chest and head. The Virgin Mary, the other three Maries and Saint John are used to bring out a striking effect on the artwork with a neutral background (Wolk-Simon, Bambach & Alsteens 127). Mannerist was used to make the painting. The artwork is associated with the 15th century in the year 1582. The artwork’s origin is in Italy in Bologna. The artwork fits in the category of the 15th-century Italian printers. The technique used to make this artwork was painting using oil on canvas material. Traditional oil painting often began with sketches onto the canvas with charcoal, chalk or thinned paint. The oil paint was then mixed with linseed oil or other solvents to create a faster drying paint. Generally, solvents thin the oil in the paint. Moreover, each additional layer should contain more oil than the layer before it, to allow proper drying. If the additional layer contains less oil, then the final painting will crack and peel. The quality and type of oil determine whether the paint film is stable and strong. Oil paint does not dry fast it remains wet for long. This enables the artist to revise their work if any correction is needed. An artist can change the color , texture or the form of the whole artwork. Earlier works were panel paintings on wood but around the 15th century canvas became more popular. Canvas was preferred by artists because it was cheaper than wood and easy to transport because it was light. Painting using oil on canvas spread through Italy from