Images in Vascular Medicine Pectoralis minor syndrome – A forgotten vascular compression syndrome

Ramcharitar, Randy K.; Elghawy, Omar; Man, Louise; Sharma, Aditya; Peruri, Aditya; Park, Auh Whan; Norton, Patrick T.; Khaja, Minhaj S.; Tripathi, Ravikesh

doi:10.1177/1358863x221110925

Cited by 2 publications

(6 citation statements)

References 3 publications

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“…[4,[10][11][12] Repetitive sports or daily activity can also cause vascular PMS. [3][4][5] The PM muscle, itself, can compress some of the vessels, or the head of the humerus exert pressure on the vascular structures during throwing and forceful overhead movements of the upper extremity. Repetitive compression also leads to intimal injury and subsequent thrombosis.…”

Section: Etiology and Pathophysiologymentioning

confidence: 99%

“…[13] It is usually associated with neurogenic symptoms of PMS due to the proximity of nerves to vascular structures, which causes pressure on the nerves. [4][5][6] Acute traumas, traffic accidents, hyperextension injuries to the neck, such as whiplash, can also have a role in the etiology of PMS. The pathogenesis of whiplash injury is complex, and reflex muscle spasms may occur in the surrounding tissues after injury.…”

Section: Etiology and Pathophysiologymentioning

confidence: 99%

“…[6,8] As aforementioned, the subclavian vein can be compressed at the costoclavicular space, and the AV can be compressed under the PM muscle. [3,5,8] Therefore, when there is venous obstruction, these two regions should be considered for entrapment. Axillary artery stenosis due to PMS results in decreased blood flow to the extremity.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…[1,2,4,28] Dynamic venography and arteriography are diagnostic in uncertain cases. [1,2,5,6,8] Magnetic resonance neurography may be used to visualize BP, and MR/CT angiography is useful in diagnosing arterial or venous TOS and PMS. [1,2] Hemodynamic testing, including finger plethysmography and pulse oximetry, may be a helpful, non-invasive, rapid, and inexpensive clinical tool in diagnosing TOS.…”

Section: Diagnosismentioning

confidence: 99%

“…Echoing this study, the literature has reported rare cases of vascular PMS. [3][4][5][6] The frequency of TOS in the general population is not known precisely. There are also quite contradictory results in the literature regarding the frequency of neurogenic and vascular TOS and PMS, since the diagnostic and classification criteria are not fully established.…”

mentioning

confidence: 99%

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Pectoralis minor syndrome

Aktaş¹

2022

Turk J Phys Med Rehab

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Pectoralis minor syndrome (PMS) is defined as compression of the brachial plexus (BP) nerves, axillary artery, and axillary vein under the pectoralis minor muscle. The symptoms of PMS resemble supraclavicular compression of the neurovascular bundle, with shoulder, neck, chest, and arm pain, and paresthesia and weakness in the arm and hand. The diagnosis of PMS can be confused with other upper extremity pain syndromes. A detailed history, including occupation, daily activities, sports, and trauma, is critical in the diagnosis, together with physical examination findings. Radiological examinations, including direct radiography, computed tomography, magnetic resonance imaging, and electrophysiological tests, are also helpful for the differential diagnosis. Arterial and venous Doppler ultrasound, including dynamic investigation, can display arterial and venous compression. Injection tests are used to confirm the definitive diagnosis. Conservative treatment is successful in most patients, and surgical treatment is considered in unresponsive cases.

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Section: Etiology and Pathophysiologymentioning

confidence: 99%

Section: Etiology and Pathophysiologymentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

mentioning

confidence: 99%

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Pectoralis minor syndrome

Aktaş¹

2022

Turk J Phys Med Rehab

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Ideal Injection Points for Botulinum Neurotoxin for Pectoralis Minor Syndrome: A Cadaveric Study

Lee,

et al. 2023

Toxins

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Pectoralis Minor Syndrome (PMS) causes significant discomfort due to the compression of the neurovascular bundle within the retropectoralis minor space. Botulinum neurotoxin (BoNT) injections have emerged as a potential treatment method; however, their effectiveness depends on accurately locating the injection site. In this study, we aimed to identify optimal BoNT injection sites for PMS treatment. We used twenty-nine embalmed and eight non-embalmed human cadavers to determine the origin and intramuscular arborization of the pectoralis minor muscle (Pm) via manual dissection and Sihler’s nerve staining techniques. Our findings showed the Pm’s origin near an oblique line through the suprasternal notch, with most neural arborization within the proximal three-fourths of the Pm. Blind dye injections validated these results, effectively targeting the primary neural arborized area of the Pm at the oblique line’s intersection with the second and third ribs. We propose BoNT injections at the arborized region within the Pm’s proximal three-fourths, or the C region, for PMS treatment. These findings guide clinicians towards safer, more effective BoNT injections.

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Images in Vascular Medicine Pectoralis minor syndrome – A forgotten vascular compression syndrome

Cited by 2 publications

References 3 publications

Pectoralis minor syndrome

Pectoralis minor syndrome

Ideal Injection Points for Botulinum Neurotoxin for Pectoralis Minor Syndrome: A Cadaveric Study

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