Thoracic outlet syndrome/TOS, a subgroup in ME/CFS? 2020 paper

[pattismith]

The paper talks about a cerebral vascular hyperperfusion (CVH) possibly produced by TOS, but some other articles suggest TOS may produce brain hypoperfusion in some cases.

TOS CVH often causes pronounced fatigue, and is a common co-finding in patients with myalgic encephalomyelitis (ME) / chronic fatigue syndrome. We also believe that the compensatory cerebroarterial vasodilation that occurs in chronic CVH may play a role in postural orthostatic tachycardia syndrome, another common sub-component of ME.

https://www.apicareonline.com/index.php/APIC/article/view/1230/2037

https://jag.journalagent.com/tbdhd/pdfs/TBDHD-16878-CASE_REPORT-GURELIK.pdf

 

[kangaSue]

I would urge anyone with TOS to also be assessed for the abdominal vascular compression syndromes of renal Nutcracker Syndrome and May-Thurner Syndrome as TOS is a condition that also crops up a fair bit in this patient cohort too, and where headaches can also be a common symptom for some.

Headaches for some of these patients has recently been identified as being due to left kidney return venous blood flow (from Nutcracker Syndrome) being directed into the lumbar vein, some of which will then presumably flow into the azygos drainage system, but this 'midline congestion' can also cause increased spinal fluid pressures and IIH along the way.

Note that it can occur with Nutcracker Phenomenon also.

Novel Use of Time-Resolved Magnetic Resonance Angiography to Evaluate Retrograde Lumbar Vein Flow and Epidural Venous Plexus Enhancement in Chronic Headache Patients With and Without Nutcracker Physiology
https://pubmed.ncbi.nlm.nih.gov/35093724/

 

[pattismith]

I would urge anyone with TOS to also be assessed for the abdominal vascular compression syndromes of renal Nutcracker Syndrome and May-Thurner Syndrome as TOS is a condition that also crops up a fair bit in this patient cohort too,

really?

I wonder if the spine posture has any effect on Nutcracker syndrome.
Spine posture is really important in TOS.
Extension of the upper spine can relieve the compression in TOS while thoracic hyperkyphosis is commonly associated with TOS

looking for an answer, I found one article that associates Nutckraker syndrome with hyperlordosis of the lumbar spine

Example for the effect of the lumbar lordosis on the compression of abdominal veins

The image below shows the severe compression of the left renal vein in a nutcracker syndrome. The compression is exerted by the anterior bulging of the lumbar spine, pressing from behind against the aorta. The uplifted aorta then compresses the left renal vein from behind, thus causing an extreme flow acceleration to 346 cm/s in a vein! This is about 15 times of the normal flow velocity in the left renal vein. The images below show the effect of the decompression by active stretching of the lumbar spine, thus counteracting the lordosis and reducing the lordotic pressure. The turbulences nearly completely disappear, and the flow velocity drops to a ninth of the former values, thus pointing to the reduction of the venous pressure in the same range.

https://info.orthocanada.com/media-...-the-untold-story-of-thoracic-outlet-syndrome

https://scholbach.de/wissenschaft/d...f-die-kompression-abdominaler-venen#gsc.tab=0

https://learnmuscles.com/blog/2018/05/02/the-critical-component-of-upper-crossed-syndrome/

 

[kangaSue]

I wonder if the spine posture has any effect on Nutcracker syndrome.

Yes, both (or eithe)r significant lumbar lordosis or lumbar scoliosis (the latter depending on which side the spinal misalignment curves to) can be factors in Nutcracker Syndrome for some, and I do know of a few people who have had significant improvement in their symptoms (of Nutcracker Syndrome) from working on correcting their posture as much as possible.