All-Endoscopic Brachial Plexus Complete Neurolysis for Idiopathic Neurogenic Thoracic Outlet Syndrome: A Prospective Case Series

Lafosse, Thibault; Hanneur, Malo Le; Lafosse, Laurent

doi:10.1016/j.arthro.2017.01.050

Cited by 27 publications

(33 citation statements)

References 37 publications

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“…Current literature assessing visibility in endoscopic approaches has reported mixed results. [64][65][66][67] Even though an endoscopic operative technique is plausible for supraclavicular repairs, it is less practical for level IV injuries of the terminal branches. There may be a higher risk of nerve injury while using an endoscopic technique for nerve decompression.…”

Section: Discussionmentioning

confidence: 99%

Pain Relief after Surgical Decompression of the Distal Brachial Plexus

Morgan

Elliot

Banala

et al. 2020

J Brachial Plex Peripher Nerve Inj

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Background Brachial plexopathy causes pain and loss of function in the affected extremity. Entrapment of the brachial plexus terminal branches within the surrounding connective tissue, or medial brachial fascial compartment, may manifest in debilitating symptoms. Open fasciotomy and external neurolysis of the neurovascular bundle in the medial brachial fascial compartment were performed as a surgical treatment for pain and functional decline in the upper extremity. The aim of this study was to evaluate pain outcomes after surgery in patients diagnosed with brachial plexopathy. Methods We identified 21 patients who met inclusion criteria. Documents dated between 2005 and 2019 were reviewed from electronic medical records. Chart review was conducted to collect data on visual analog scale (VAS) for pain, Semmes-Weinstein monofilament test (SWMT), and Medical Research Council (MRC) scale for muscle strength. Pre- and postoperative data was obtained. A paired sample t-test was used to determine statistical significance of pain outcomes. Results Pain severity in the affected arm was significantly reduced after surgery (pre: 6.4 ± 2.5; post: 2.0 ± 2.5; p < 0.01). Additionally, there was an increased response to SWMT after the procedure. More patients achieved an MRC rating score ≥3 and ≥4 in elbow flexion after surgery. This may be indicative of improved sensory and motor function. Conclusion Open fasciotomy and external neurolysis at the medial brachial fascial compartment is an effective treatment for pain when nerve continuity is preserved. These benefits were evident in patients with a prolonged duration elapsed since injury onset.

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Section: Discussionmentioning

confidence: 99%

Pain Relief after Surgical Decompression of the Distal Brachial Plexus

Morgan

Elliot

Banala

et al. 2020

J Brachial Plex Peripher Nerve Inj

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“…During the use of this technique, the axillary and musculocutaneous nerves, as well as the brachial plexus and vessels, must be located so as not to injure them, as described by Lafosse et al. 2 , 8 for the arthroscopic Latarjet procedure. After conservative treatment failure, we suggest that this condition can be successfully treated with arthroscopic loose body removal and synovectomy through an endoscopic subcoracoid approach using a medial transpectoral portal.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the advantages of the arthroscopic surgical procedure, this medial approach offers good visualization of the plexus after pectoralis minor release, therefore allowing the reduction of any potential damage to the brachial plexus owing to optimal visualization of the musculocutaneous nerve and axillary nerve. 2 …”

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confidence: 99%

Arthroscopic and Endoscopic Technique for Subcoracoid Synovial Chondromatosis of the Shoulder Through a Medial Transpectoral Portal

Aramberri

Tiso²,

Haeni

2018

Arthroscopy Techniques

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Synovial chondromatosis of the shoulder is a rare disorder characterized by metaplastic synovial proliferation, causing multiple loose bodies usually localized intra-articularly. Surgical treatment with open techniques through a deltopectoral approach has been commonly used. The evolution of arthroscopy has allowed a complete joint assessment and the extraction of intra-articular loose bodies with less morbidity than open techniques. Nevertheless, this pathology occurs less frequently in the subcoracoid bursa. Access to this bursa may be more complicated when extracting loose bodies that cause pain and functional limitation in performing activities of daily living. We describe an arthroscopic and endoscopic technique for the treatment of subcoracoid synovial chondromatosis through a medial transpectoral portal, allowing safe loose body extraction under direct visualization around the coracoid process and brachial plexus. The literature was reviewed, and benefits of this endoscopic technique were analyzed.

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“…There appears to be a place for arthroscopic neurolyses in the shoulder region, because even release of the brachial plexus has recently been suggested with good results for the treatment of thoracic outlet syndrome. 3,4 Personally, I have not read any reports outlining preoperative distal neuropathy in an elective case treated for another condition than neuropathy. Nor did I find any information when running a quick Medline search.…”

Section: See Related Article On Page 1186mentioning

confidence: 99%