Thoracic Outlet Syndrome Publications (2488)


Thoracic Outlet Syndrome Publications

J Brachial Plex Peripher Nerve Inj
J Brachial Plex Peripher Nerve Inj 2016 10;11(1):e21-e28. Epub 2016 May 10.
Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, United States.

Rationale Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited. Objective We report a case of a variant DSA path, and revisit DSA origins and under-investigated relationship with the plexus in cadavers. Methods The DSA was examined in a male patient and 106 cadavers. Read More

Results In the case, we observed an unusual DSA compressing the lower plexus trunk, that resulted in intermittent radiating pain and paresthesia. In the cadavers, the DSA originated most commonly from the subclavian artery (71%), with 35% from the thyrocervical trunk. Nine sides of eight cadavers (seven females) had two DSA branches per side, with one branch from each origin. The most typical DSA path was a subclavian artery origin before passing between upper and middle brachial plexus trunks (40% of DSAs), versus between middle and lower trunks (23%), or inferior (4%) or superior to the plexus (1%). Following a thyrocervical trunk origin, the DSA passed most frequently superior to the plexus (23%), versus between middle and lower trunks (6%) or upper and middle trunks (4%). Bilateral symmetry in origin and path through the brachial plexus was observed in 13 of 35 females (37%) and 6 of 17 males (35%), with the most common bilateral finding of a subclavian artery origin and a path between upper and middle trunks (17%). Conclusion Variability in the relationship between DSA and trunks of the brachial plexus has surgical and clinical implications, such as diagnosis of thoracic outlet syndrome.

Thorac Cardiovasc Surg Rep
Thorac Cardiovasc Surg Rep 2016 Dec 16;5(1):74-76. Epub 2015 Dec 16.
Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, New York, United States.

Aneurysmal bone cyst is a rare benign cystic bone lesion with an incidence of only 0.14 per 100,000 individuals and most commonly affects the metaphyses of long bones, spine, and pelvis. We present a very rare case of a 17-year-old boy with a rapidly expanding aneurysmal bone cyst arising from the first rib, resulting in neurogenic thoracic outlet syndrome secondary to its compression of the brachial plexus. Read More

The patient's symptoms resolved after en bloc resection. To our knowledge there have been no other reports in the literature of thoracic outlet syndrome due to aneurysmal bone cyst arising from the first rib.

Muscle Nerve
Muscle Nerve 2016 Dec 22. Epub 2016 Dec 22.
Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Muscle Nerve
Muscle Nerve 2016 Dec 22. Epub 2016 Dec 22.
Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Semin Musculoskelet Radiol
Semin Musculoskelet Radiol 2016 Nov 21;20(5):441-452. Epub 2016 Dec 21.
Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

Botulinum toxin (BTX) is used for multiple clinical indications due to its ability to induce temporary chemodenervation and muscle paralysis. This property has supported its application in treating a variety of musculoskeletal conditions, especially those involving muscular hyperactivity and contractures such as cerebral palsy and dystonia. However, off-label use of BTX injection in other musculoskeletal disorders is gaining increased acceptance, such as in neurogenic thoracic outlet syndrome, epicondylitis, and shoulder pain after stroke. Read More

This review discusses the mechanism of action, best practices, and current indications of BTX injections in the musculoskeletal system. We also discuss the state of the science regarding BTX injections for musculoskeletal disorders and the available evidence supporting its use.

Cervical ribs have been reported to be present in about 0.5% of the general population, 10% of patients with cervical rib who are symptomatic usually have neurogenic symptoms, but some have arterial symptoms. In 1861, Coote was the first to excise a cervical rib through a supraclavicular approach and relieved the symptoms of thoracic outlet syndrome. Read More

in this work we address the efficacy and safety of a modification to the supraclavicular approach for resection of symptomatic cervical ribs.
The surgical team in collaboration with anatomist performed cadaveric dissections of the posterior triangle of the neck in the anatomy department, Ain Shams University. A prospective study was done on twenty five patients with moderate to severe neck or upper limb pain; this pain was resistant to medical treatment for at least six months. Pre-operative cervical X-Rays showed cervical ribs. Pain was assessed by using the visual analogue scale (VAS). Electrophysiological tests were performed to confirm the diagnosis. In this study, we performed a modified supraclavicular interscalene approach with resection of the symptomatic rib and without resecting either of the scalene muscles or the first thoracic rib.
A total of 25 patients were included in this study, the mean age was 36 years (±12 SD), and the mean follow up period was 12.3 months. All patients had a preoperative moderate (28%) to severe (72%) pain. Motor deficits were present in six cases (24%); Sensory manifestations were present in (80%). All patients had a relief of the severe pain at the first post-operative visit in the first week. There were improvements in the motor power in five out of the six patients who had pre-operative motor deficit.
Modified supraclavicular interscalene approach for resection of symptomatic cervical ribs has shown to be effective in the treatment of neuralgic pain. In comparison to other approaches, it proved to be less invasive, with small transverse incision and without resection of scalenus anterior muscle.

Neurol. Sci.
Neurol Sci 2016 Dec 16. Epub 2016 Dec 16.
Department of Geriatrics, Neurosciences and Othopaedics, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.

Despite its low prevalence and incidence, considerable debate exists in the literature on thoracic outlet syndrome (TOS). From literature analysis on nerve entrapments, we realized that TOS is the second most commonly published entrapment syndrome in the literature (after carpal tunnel syndrome) and that it is even more reported than ulnar neuropathy at elbow, which, instead, is very frequent. Despite the large amount of articles, there is still controversy regarding its classification, clinical picture, diagnostic objective findings, diagnostic modalities, therapeutical strategies and outcomes. Read More

While some experts believe that TOS is underrated, overlooked and very frequent, others even doubt its existence as a nosological entity. In the attempt to shed more light on this condition, we performed a systematic review of the literature and report evidence and opinions around this controversial subject. Only articles focused on neurogenic TOS were considered. Understanding the status of the art and the underlying reasons of doubts and weaknesses could help clinical practice and set the stage for future research.

Ann Vasc Surg
Ann Vasc Surg 2016 Dec 12. Epub 2016 Dec 12.
Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Aurora, CO; Department of Radiology, Presbyterian/St. Luke's Medical Center, Denver, CO. Electronic address:

Transaxillary approach to first rib resection and scalenectomy (TAFRRS) is a well-established technique for treatment of thoracic outlet syndrome (TOS). Although anatomic features encountered during TAFRRS are in general constant, vascular anomalies may be encountered but have not been described to date. Herein we describe vascular abnormalities encountered during TAFRRS. Read More

We performed a retrospective review of a prospective practice database of 224 operations for TOS performed in 172 patients from March 2000 to March 2014. We excluded 10 patients with missing operative reports, 3 reoperations on the same patient, and 8 non-transaxillary resections. We recorded vascular anomalies identified in operative reports and reviewed computed tomography imaging to delineate the nature of these abnormalities.
The overall incidence of vascular anomalies was 11% (22 of 203 TAFRRS). Most patients with anomalies had venous TOS (vTOS) (9 patients, 41%), followed by 7 (32%) with neurogenic TOS (nTOS). The remainder of the patients had arterial TOS (aTOS) (6 patients, 27%). Seven patients (32%) had an abnormal subclavian artery (SCA) with 5 (23%) having an abnormal arterial course in the anterior scalene muscle (ASM); 6 patients (27%) had an abnormal internal mammary artery (IMA) originating from distal SCA; 4 (18%) had abnormalities in the supreme thoracic artery (bifurcation or duplication); 2 (9%) had an abnormal branch from the SCA with anomalous location in the operative field; and 3 (14%) had an abnormal large venous branch penetrating the ASM. In the 19 patients with arterial anomalies, 8 (42%) were recognized as arterial branches penetrating the ASM, and 11 (58%) were noticed as they had anomalous arterial locations within the operative field. Most arterial anomalies were seen in vTOS (9, 45%), followed by nTOS (7, 35%). No intraoperative vascular complications occurred. Perioperative complications included 1 occurrence of postoperative transfusion for bleeding following axillary drain discontinuation and 2 Horner's syndromes. One aberrant IMA was electively ligated to allow complete thoracic outlet decompression.
Arterial anomalies during TAFRRS are encountered in 11% of operations, and may present with vessel locations in unusual areas within the operative field, or as abnormal vessels penetrating the ASM, thus making scalenectomy precarious. Careful attention must be paid to possible abnormal locations of vessels in the thoracic outlet to avoid bleeding complications.

Mil Med
Mil Med 2016 Nov;181(11):e1706-e1710
Division of Vascular Surgery, Department of Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134.

The upper extremity is an uncommon site for deep vein thrombosis and, although most of these thrombotic events are secondary to catheters or indwelling devices, venous thoracic outlet syndrome is an important cause of primary thrombosis. Young, active, otherwise healthy individuals that engage in repetitive upper extremity exercises, such as those required by a military vocation, may be at an increased risk. We present the case of a Naval Officer diagnosed with venous thoracic outlet syndrome whereby a multimodal approach with early surgical decompression was used. Read More

Although thoracic outlet decompression by means of first rib resection is the standard of care, timing of first rib resection after thrombolysis is debated. With respect to the active duty service member, the optimal timing of additional postoperative interventions for residual venous defects and duration of anticoagulation remain in question. A more streamlined perioperative treatment regimen may benefit the military patient without jeopardizing the quality of care and allow more expeditious return to full duty.