scholarly journals Supraclavicular Resection of a Cervical Rib Causing Thoracic Outlet Syndrome: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (5) ◽  
pp. E520-E520
Author(s):  
Stephen Shelby Burks ◽  
Erin M Wolfe ◽  
Jang Won Yoon ◽  
Allan D Levi
Keyword(s):  
Brachial Plexus ◽  
Clinical Improvement ◽  
Anterior Approach ◽  
Thoracic Outlet Syndrome ◽  
Cervical Vertebrae ◽  
Cervical Rib ◽  
Rib Resection ◽  
Lower Trunk ◽  
Neurogenic Thoracic Outlet Syndrome

Abstract Presence of a cervical rib results from overdevelopment of the seventh cervical vertebrae.1-3 The cervical rib along with scalene muscles can cause neurogenic thoracic outlet syndrome.4,5 Rib resection is typically done via anterior approach, using either supraclavicular or transaxillary route.6,7 We present an operative video detailing supraclavicular resection of a cervical rib causing neurogenic thoracic outlet syndrome with direct decompression of the lower trunk of the brachial plexus. The patient presented with severe symptoms including hand atrophy. We were able to directly visualize the rib and resect it, along with scalene musculature. We present 3-mo follow-up data noting clinical improvement in neuropathic symptoms.

Neurogenic Thoracic Outlet Syndrome

2018 ◽  
Author(s):  
Pascal Lavergne ◽  
Hélène T. Khuong
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Botulinum Toxin Injection ◽  
Signs And Symptoms ◽  
Nerve Blocks ◽  
Initial Management ◽  
Supraclavicular Approach ◽  
Lower Trunk ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Electrophysiologic Studies

Neurogenic thoracic outlet syndrome is an entrapment neuropathy involving the brachial plexus along its trajectory from the cervical spine to the axilla. Clinical presentation includes cervical and upper extremity pain as well as neurologic signs and symptoms in the lower trunk territory. Radiologic and electrophysiologic studies are helpful adjuncts in correctly identifying the site of compression. Initial management is usually conservative, with medication, physical therapy, nerve blocks, or botulinum toxin injection. Surgery often consists of brachial plexus neurolysis and removal of compression points through the supraclavicular approach. Good outcomes can be expected with careful patient selection, but available literature is of limited quality.

Histopathological basis for neurogenic thoracic outlet syndrome

2008 ◽  
Vol 8 (4) ◽  
pp. 347-351 ◽  
Author(s):  
R. Shane Tubbs ◽  
Robert G. Louis ◽  
Christopher T. Wartmann ◽  
Robert Lott ◽  
Gina D. Chua ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Immunohistochemical Analysis ◽  
Histopathological Changes ◽  
Histological Findings ◽  
Histological Changes ◽  
Cervical Rib ◽  
Lower Trunk ◽  
Human Cadavers ◽  
Cervical Ribs

Object To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression. Methods Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42%) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs. Results The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified. Conclusions Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.

scholarly journals Case Report: Neurogenic Thoracic Outlet Syndrome Without Electrophysiologic Abnormality

2021 ◽  
Vol 12 ◽  
Author(s):  
Sun Woong Kim ◽  
Duk Hyun Sung
Keyword(s):  
Brachial Plexus ◽  
Ct Angiography ◽  
Clinical Features ◽  
Thoracic Outlet Syndrome ◽  
Imaging Techniques ◽  
Neurovascular Bundle ◽  
Brachial Plexopathy ◽  
Lower Trunk ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Electrophysiologic Studies

Neurogenic thoracic outlet syndrome (N-TOS) is a chronic compressive brachial plexopathy that involves the C8, T1 roots, and/or lower trunk. Medial antebrachial cutaneous (MABC) nerve conduction study (NCS) abnormality is reportedly one of the most sensitive findings among the features of N-TOS. The aim of the present study was to report clinical features, imaging findings, treatment, and prognoses of two N-TOS patients with no abnormalities in electrophysiological studies. Both patients presented with paresthesia of unilateral arm, and examination revealed no neurologic deficits. Electrophysiologic studies including MABC NCS were normal. Computed tomography (CT) angiography and brachial plexus magnetic resonance imaging (MRI) of the patients showed compression and displacement of the neurovascular bundle in the thoracic outlet by causative structures. Due to their sensory symptoms and CT angiography and brachial plexus MRI findings, after excluding other diseases, we diagnosed them with N-TOS. With the development of imaging techniques, more patients presenting with clinical features of lower trunk brachial plexopathy and anomalous structures compressing the neurovascular bundle on imaging studies can be diagnosed with N-TOS, even if electrophysiologic studies including MABC NCS do not show abnormalities.

Diffuse Idiopathic Skeletal Hyperostosis Presenting with Thoracic Outlet Syndrome and Dysphagia

Neurosurgery ◽  
1988 ◽  
Vol 22 (6P1-P2) ◽  
pp. 1071-1074 ◽  
Author(s):  
Randy O. Kritzer ◽  
Janies E. Rose
Keyword(s):  
Brachial Plexus ◽  
Anterior Approach ◽  
Thoracic Outlet Syndrome ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Direct Visualization ◽  
Transaxillary Approach ◽  
Rib Resection ◽  
Anatomical Anomaly

Abstract A case of diffuse idiopathic skeletal hyperostosis (DISH) presenting with thoracic outlet syndrome and dysphagia is reported. Although extraspinal manifestations have been reported in these patients, thoracic outlet syndrome, particularly the anatomical anomaly found at operation, is previously unreported in patients with DISH. In addition to discussing DISH and thoracic outlet syndrome, we readvocate the anterior approach for 1st rib resection that was introduced in 1967 by Gol and associates. The direct visualization offered by this approach allowed us to avoid a potential injury to the brachial plexus that may have occurred had the transaxillary approach been used.

scholarly journals Long-term outcomes after surgical treatment of pediatric neurogenic thoracic outlet syndrome

2018 ◽  
Vol 21 (1) ◽  
pp. 54-64 ◽  
Author(s):  
Jennifer Hong ◽  
Jared M. Pisapia ◽  
Zarina S. Ali ◽  
Austin J. Heuer ◽  
Erin Alexander ◽  
...  
Keyword(s):  
Pain Relief ◽  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Univariate Analysis ◽  
Patient Characteristics ◽  
Neurological Deficits ◽  
Duration Of Symptoms ◽  
Neurogenic Thoracic Outlet Syndrome

OBJECTIVENeurogenic thoracic outlet syndrome (nTOS) is an uncommon compression syndrome of the brachial plexus that presents with pain, sensory changes, and motor weakness in the affected limb. The authors reviewed the clinical presentations and outcomes in their series of pediatric patients with surgically treated nTOS over a 6-year period.METHODSCases of nTOS in patients age 18 years or younger were extracted for analysis from a prospective database of peripheral nerve operations. Baseline patient characteristics, imaging and neurophysiological data, operative findings, and outcomes and complications were assessed.RESULTSTwelve patients with 14 cases of nTOS surgically treated between April 2010 and December 2016 were identified. One-third of the patients were male, and 2 male patients underwent staged, bilateral procedures. Disabling pain (both local and radiating) was the most common presenting symptom (100%), followed by numbness (35.7%), then tingling (28.6%). The mean duration of symptoms prior to surgery was 15.8 ± 6.6 months (mean ± SD). Sports-related onset of symptoms was seen in 78.6% of cases. Imaging revealed cervical ribs in 4 cases, prominent C-7 transverse processes in 4 cases, abnormal first thoracic ribs in 2 cases, and absence of bony anomalies in 4 cases. Neurophysiological testing results were normal in 85.7% of cases. Conservative management failed in all patients, with 5 patients reporting minimal improvement in symptoms with physical therapy. With a mean follow-up after surgery of 22 ± 18.3 months (mean ± SD), pain relief was excellent (> 90%) in 8 cases (57.1%), and good (improved > 50%) in 6 cases (42.9%). On univariate analysis, patients who reported excellent pain resolution following surgery at long-term follow-up were found to be significantly younger, and to have suffered a shorter duration of preoperative symptoms than patients who had worse outcomes. Lack of significant trauma or previous surgery to the affected arm was also associated with excellent outcomes. There were 4 minor complications in 3 patients within 30 days of surgery: 1 patient developed a small pneumothorax that resolved spontaneously; 1 patient suffered a transient increase in pain requiring consultation, followed by hiccups for a period of 3 hours that resolved spontaneously; and 1 patient fell at home, with transient increased pain in the surgically treated extremity. There were no new neurological deficits, wound infections, deep vein thromboses, or readmissions.CONCLUSIONPediatric nTOS commonly presents with disabling pain and is more frequently associated with bony anomalies compared with adult nTOS. In carefully selected patients, surgical decompression of the brachial plexus results in excellent pain relief, which is more likely to be seen in younger patients who present for early surgical evaluation.

scholarly journals A Comparison of Surgical Approaches for Cervical Rib Resection for Neurogenic Thoracic Outlet Syndrome

2014 ◽  
Vol 59 (2) ◽  
pp. 568
Author(s):  
Arjun Jayaraj ◽  
Audra A. Duncan ◽  
Manju Kalra ◽  
Thomas C. Bower ◽  
Peter Gloviczki
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Surgical Approaches ◽  
Cervical Rib ◽  
Rib Resection ◽  
Neurogenic Thoracic Outlet Syndrome

scholarly journals Neurogenic Thoracic Outlet Syndrome with Supraclavicular Release: Long-Term Outcome without Rib Resection

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 450
Author(s):  
Niina Ruopsa ◽  
Leena Ristolainen ◽  
Martti Vastamäki ◽  
Heidi Vastamäki
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Long Term Results ◽  
Preoperative Pain ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Rib Resection ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Functional Outcome Measures

Our aim was to define clinical long-term outcome of surgery for neurogenic thoracic outlet syndrome without rib resection, and to find factors predicting long-term results. For the 94 patients, the main outcomes were pain, numbness, weakness, and upper-extremity function. The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) survey, the Cervical-Brachial Symptom Questionnaire (CBSQ), and a numerical rating system served as functional outcome measures. Mean follow-up was 12.9 years. Preoperative pain diminished from 7.8 to 2.2, numbness from 7.4 to 4.0, and weakness from 7.3 to 3.8. Grip strength increased from 25.7 to 31.8 kg. QuickDASH averaged at follow-up 37.1 and CBSQ 51.5. No correlation appeared between smoking and long-term results regarding pain, numbness, weakness, or functioning. Positive TOS provocative tests or intraoperative anatomical findings like consistency of the scaleni muscles showed no correlation with outcome. 82% of female and 57% of male patients reported that aid from this surgery had been excellent or good; 69% reported that surgery helped considerably for at least a mean 9.9 years. The risk for worse self-reported long-term outcome was higher among men, but neither BMI nor age at surgery associated with self-reported outcome. Pain, numbness, and weakness significantly decreased and function improved after supraclavicular release without rib resection. We found no significant preoperative nor per-operative factors predicting long-term results.

scholarly journals Morbidity of First Rib Resection in the Surgical Repair of Thoracic Outlet Syndrome

Hand ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 636-640 ◽  
Author(s):  
Kevin T. Jubbal ◽  
Dmitry Zavlin ◽  
Joshua D. Harris ◽  
Shari R. Liberman ◽  
Anthony Echo
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Operative Time ◽  
Medical Complications ◽  
Complication Rates ◽  
Improvement Program ◽  
Cervical Rib ◽  
Rib Resection ◽  
First Rib ◽  
Increased Risk ◽  
First Rib Resection

Background: Thoracic outlet syndrome (TOS) is a complex entity resulting in neurogenic or vascular manifestations. A wide array of procedures has evolved, each with its own benefits and drawbacks. The authors hypothesized that treatment of TOS with first rib resection (FRR) may lead to increased complication rates. Methods: A retrospective case control study was performed on the basis of the National Surgical Quality Improvement Program database from 2005 to 2014. All cases involving the operative treatment of TOS were extracted. Primary outcomes included surgical and medical complications. Analyses were primarily stratified by FRR and secondarily by other procedure types. Results: A total of 1853 patients met inclusion criteria. The most common procedures were FRR (64.0%), anterior scalenectomy with cervical rib resection (32.9%), brachial plexus decompression (27.2%), and anterior scalenectomy without cervical rib resection (AS, 8.9%). Factors associated with increased medical complications included American Society of Anesthesiologists (ASA) classification of 3 or greater and increased operative time. The presence or absence of FRR did not influence complication rates. Conclusions: FRR is not associated with an increased risk of medical or surgical complications. Medical complications are associated with increased ASA scores and longer operative time.

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