scholarly journals A modified, less invasive posterior subscapular approach to the brachial plexus: case report and technical note

2017 ◽  
Vol 42 (3) ◽  
pp. E7 ◽  
Author(s):  
Clifford L. Crutcher ◽  
David G. Kline ◽  
Gabriel C. Tender
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Postoperative Morbidity ◽  
Technical Note ◽  
Brachial Plexopathy ◽  
Less Invasive ◽  
Levator Scapulae ◽  
Anterior Operation ◽  
Minor Muscle

The traditional posterior subscapular approach offers excellent exposure of the lower brachial plexus and has been successfully used in patients with recurrent thoracic outlet syndrome after an anterior operation, brachial plexus tumors involving the proximal roots, and postirradiation brachial plexopathy, among others. However, this approach also carries some morbidity, mostly related to the extensive muscle dissection of the trapezius, rhomboids, and levator scapulae. In this article, the authors present the surgical technique and video illustration of a modified, less invasive posterior subscapular approach, using a small, self-retaining retractor and only a partial trapezius and rhomboid minor muscle dissection. This approach is likely to result in decreased postoperative morbidity and a shorter hospital stay.

Case 13

2018 ◽  
Author(s):  
Bashar Katirji
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Brachial Plexus ◽  
Carpal Tunnel ◽  
Thoracic Outlet Syndrome ◽  
Median Sternotomy ◽  
Cubital Tunnel Syndrome ◽  
Brachial Plexopathy ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Tunnel Syndrome ◽  
Neurogenic Disorder

Thoracic outlet syndrome remains a controversial syndrome despite being described more than a century ago. This syndrome has neurogenic, vascular, and disputed types. True neurogenic thoracic outlet syndrome is relatively rare syndrome often associated with a cervical rib or cervical band. Symptoms include pain, hand and forearm numbness, and hand weakness and atrophy. The true neurogenic disorder has classical electrodiagnostic presentations. This case highlights the anatomy of the brachial plexus and distinguishes true neurogenic thoracic outlet syndrome from carpal tunnel syndrome, cubital tunnel syndrome, C8 radiculopathy, T1 radiculopathy, and post-median sternotomy brachial plexopathy, with emphasis on the electrodiagnostic findings.

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.

Posterior subscapular approach to the brachial plexus

1993 ◽  
Vol 79 (3) ◽  
pp. 319-330 ◽  
Author(s):  
Annie S. Dubuisson ◽  
David G. Kline ◽  
Steven S. Weinshel
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Anterior Chest Wall ◽  
Spinal Nerve ◽  
Brachial Plexopathy ◽  
Brachial Plexus Palsy ◽  
Content Type ◽  
Spinal Nerves ◽  
Operative Experience ◽  
Prior Operation

✓ A 15-year operative experience with 105 posterior subscapular approaches to the brachial plexus in 102 patients is presented. The procedure is indicated in carefully selected cases, especially where the proximal portions of lower spinal nerves are involved. Its main advantage is proximal exposure of the plexus spinal nerves, particularly at an intraforaminal level. The indications in this series were thoracic outlet syndrome (TOS) in 51 carefully selected procedures, brachial plexus tumor involving proximal roots in 22 patients, post-irradiation brachial plexopathy in 14 cases, and proximal traumatic brachial plexus palsy in 18 patients. Thoracic outlet syndrome associated with neurological loss, recurrent TOS after a prior operation, or proximal brachial plexus surgical lesions involving the spinal nerve(s), especially at an intraforaminal level, can be approached advantageously by such a posterior subscapular approach. The technique should also be considered when prior operation, trauma, or irradiation to the neck or anterior chest wall make a posterior exploration of the plexus easier than an anterior one. Anterior exposure of the plexus is the preferable approach for the majority of lesions needing an operation, but the posterior subscapular procedure can be useful in well-selected cases.

scholarly journals The role of the ultrasound examination of the brachial plexus in thoracic outlet syndrome

2020 ◽  
Vol 10 (1) ◽  
pp. 43-52
Author(s):  
D. S. Druzhinin ◽  
S. S. Nikitin ◽  
L. M. Boriskina ◽  
E. S. Druzhinina ◽  
M. L. Novikov ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Axillary Artery ◽  
Stress Test ◽  
Diagnostic Algorithm ◽  
Pectoralis Minor ◽  
Ultrasound Evaluation ◽  
Ultrasound Study ◽  
Pectoralis Minor Muscle ◽  
Minor Muscle

Introduction. Difficulties in determining the compression of the neurovascular bundle with the thoracic outlet syndrome raises the question of finding an accessible and reproducible method for the neuroimaging of the brachial plexus and surrounding tissues.Purpose of the study – to develop an ultrasound diagnostic algorithm using a stress test to determine the level and cause of brachial plexus compression in comparison with the results of a clinical assessment.Materials and methods. 111 patients with verified compression of the brachial plexus at the level of the interstitial (65.7 %) and bone-clavicular space (21.6 %), as well as the tendon of the pectoralis minor muscle (12.6 %) were examined. The study protocol including the Adson ultrasound stress test, the assessment of the lower trunk in the interstitial space, and the test with ultrasound evaluation of the axillary artery at the level of the tendon of the pectoralis minor muscle with passive abduction of the arm back and up was used.Conclusion. An ultrasound study of the brachial plexus demonstrated informativeness in assessing the level and possible cause of compression, which opens up the possibility of using the method in routine neurological practice.

scholarly journals Claviculectomía total como procedimiento de rescate. Reporte de un caso y revisión bibliográfica. [Total claviculectomy as a rescue procedure. Case report and literature review.]

2018 ◽  
Vol 83 (2) ◽  
pp. 124
Author(s):  
Santiago Argüelles ◽  
Martin Rodriguez ◽  
Enrique Pereira
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Thoracic Outlet Syndrome ◽  
Symptom Relief ◽  
Functional Results ◽  
Therapeutic Options ◽  
Brachial Plexopathy ◽  
Literature Analysis ◽  
Non Union ◽  
Rescue Procedure

<p>La pseudoartrosis de clavícula es una causa infrecuente de síndrome de opérculo torácico. En el presente artículo describimos un caso de plexopatía braquial por pseudoartrosis previamente infectada de clavícula en el cual se realizó claviculectomía total para el alivio de los síntomas. Realizamos una revisión bibliográfica del tema. Escasos artículos han sido publicados. Del análisis de la literatura citada concluimos que la claviculectomía total es una opción a ser tenida en cuenta cuando se han agotado las opciones terapéuticas. Los resultados funcionales pueden ser satisfactorios cuando la indicación es por infección, plexopatía o por sarcoma.</p><p> </p><p><strong>Abstract</strong></p><p><strong></strong><br />Clavicle non-union is an uncommon cause of thoracic outlet syndrome. A case of brachial plexopathy by previously infected clavicle pseudarthrosis is described. Total claviculectomy was performed for symptom relief. From literature analysis we conclude that total claviculectomy is an option to be taken into account when therapeutic options have exhausted.<br />Functional results could be adequate when total claviculectomy is indicated in cases of infection, plexopathy or sarcoma.</p>

Our Surgical Strategy for Thoracic Outlet Syndrome

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Yasuhiro Nakajima
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Vascular Compression ◽  
Compression Tests ◽  
Provocation Tests ◽  
Diagnosis Method ◽  
Tunnel Syndrome ◽  
Electrophysiological Examination ◽  
Sensory Neural ◽  
Plexus Block

Surgical treatment for thoracic outlet syndrome (TOS) is a very controversial surgery because objective diagnosis, such as image and electrophysiological examination, is very difficult. Clinical provocation tests including brachial plexus compression tests, such as Morley and Roos, and vascular compression tests, such as Wright and Eden ,are not high in specificity and are likely to be positive even in healthy persons and patients with carpal tunnel syndrome. We place emphasis on the laterality of latency and amplitude in the sensory neural action potential (SNAP) of the medial antebrachial cutaneous nerve and ulnar nerve. After enough stretching exercises of scapular stabilizers and brachial plexus block, we always select surgery. In this presentation, I would like to show our diagnosis method and treatment strategy including surgery.

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