Rib Pressure Causing Brachial Plexus Paralysis

Bramwell, Edwin; Dykes, H. B.

doi:10.1097/00005053-192301000-00051

Cited by 3 publications

(3 citation statements)

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“…That year, for the first time, Buzzard described seven patients with "neurologic" symptoms of the upper extremity whose symptoms were attributed to compression of the brachial plexus by a cervical rib (7). Thereafter, "CRS" was defined as: neurovascular symptoms in the upper extremity which resulted from compression of the SA or the brachial plexus in the presence of a cervical rib (8). The diagnosis of CRS was facilitated by the advent of X-ray technology in the turn of the twentieth century.…”

Section: Historical Perspectivementioning

confidence: 99%

Robotic first rib resection for thoracic outlet syndrome

Gharagozloo¹,

Atiquzzaman²,

Meyer³

et al. 2021

J Thorac Dis

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Robotic resection of the "offending portion" of the first rib in patients with thoracic outlet syndrome (TOS) has been associated with excellent results. The results have been due to (I) a better understanding of the pathogenesis of TOS, and (II) the technical advantages of the robotic platform.This article outlines the recent understanding of the pathogenesis of TOS, and reports the experience with robotic resection of the "offending portion" of the first rib in patients with neurogenic and venous TOS. Patients diagnosed with TOS underwent robotic first rib resection. Diagnosis of TOS was made by magnetic resonance angiography (MRA). On a thoracoscopic platform, the robot was used to dissect the "offending portion" of the first rib. A total of 162 patients underwent robotic first rib resection. Eighty-three patients underwent robotic first rib resection for Paget-Schroetter syndrome (PSS) (venous TOS). There were 49 men and 34 women. Mean age was 24±8.5 years. Operative time was 127.6±20.8 minutes. Median hospitalization was 4 days. There were no surgical complications, neurovascular injuries, or mortality. At a median follow-up of 24 months, all patients had an open subclavian vein (SV) for a patency rate of 100%.Seventy-nine patients underwent robotic first rib resection for neurologic symptoms of the upper extremity (neurogenic TOS). There were 29 men and 50 women. Mean age was 34±9.5 years. Operative time was 87.6±10.8 minutes. There were no intraoperative complications. Hospital stay ranged from 2-4 days with a median hospitalization of 3 days. There were no neurovascular complications. There was no mortality. In patients with neurogenic symptoms, Quick DASH Scores (mean ± SEM) decreased from 60.3±2.1 preoperatively to 5±2.3 in the immediate postoperative period, and 3.5±1.1 at 6 months (P<0.0001). Immediate relief of symptoms was seen in 71/79 (91%) patients. Persistent paresthesia was seen in 9/79 (9%) immediately postop and 3/79 (3.8%) patients at 6 months. Following the appropriate identification of the "offending portion" of the first rib which results in compression of the SV at its junction with the innominate vein by MRA, robotic resection of the "offending portion" of the first rib allows is associated with excellent results.

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Section: Historical Perspectivementioning

confidence: 99%

Robotic first rib resection for thoracic outlet syndrome

Gharagozloo¹,

Atiquzzaman²,

Meyer³

et al. 2021

J Thorac Dis

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“…Earlier accounts of the effects of cervical ribs might seem to have delineated the neurological syndrome so clearly that further description is unnecessary (Howell, 1907(Howell, , 1913Bramwell and Dykes, 1921;Sargent, 1921;Wilson, 1913Wilson, , 1940. For example, the presence of selective thenar wasting in this condition was clearly described by Wilson as early as 1913.…”

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confidence: 99%

Wasting of the hand associated with a cervical rib or band

Gilliatt

Quesne

Logue

et al. 1970

Journal of Neurology, Neurosurgery & Psychiatry

224

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SUMMARY Nine patients are described with unilateral wasting of the hand muscles associated with elongated C7 transverse processes or with rudimentary cervical ribs. In three patients there was selective wasting of the lateral part of the thenar pad, accompanied by mild weakness of the other hand muscles. In four patients all the hand muscles were wasted, but this was more marked in the lateral part of the thenar pad than elsewhere. In two patients wasting was uniformly distributed throughout the hand. Weakness and wasting in the forearm was only present in four patients and was relatively mild. Sensory loss, when present, affected mainly the inner side of the forearm. Nerve conduction studies revealed no abnormality in the distal part of the median nerve, but some patients had reduced or absent sensory action potentials when the fifth finger was stimulated. In all nine patients a sharp fibrous band was found at operation, which extended from an elongated C7 transverse process or from a rudimentary cervical rib to the region of the scalene tubercle on the first rib. The fibrous band caused angulation of the C8 and TI roots in five patients, and of the lower trunk of the brachial plexus in three. Pathological changes were frequently visible in affected nerves at the site of angulation. Division of the fibrous band relieved pain and paraesthesiae in eight patients and atrested muscle wasting and weakness in nine patients. There was, however, only slight recovery of power in affected muscles; wasting in the hand appeared to be unchanged after periods of up to eight years.

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“…[8,9] The term "costoclavicular syndrome" was first used by Telford and Mottershead in 1947. [10] It was observed that in patients with upper extremity neurovascular symptoms, the subclavian vein was compressed on the medial aspect of the first rib at its "v" junction with the clavicle. In retrospect, this is a different interpretation of an observation of a phenomenon that was interpreted by other investigators as the scalenus anticus syndrome (Naffziger syndrome).…”

Section: Costoclavicular Syndrome/ Costoclavicularmentioning

confidence: 99%

Modern Diagnosis and Surgical Management of Thoracic Outlet Syndrome: A Comprehensive Review

2021

AJSRR

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Conventionally TOS has been thought to represent a group of diverse disorders that result in compression of the neurovascular bundle exiting the thoracic outlet. Until recently, TOS classification has been based on symptoms, rather than the underlying pathology, with the subgroups consisting of neurogenic (NTOS), venous (VTOS or PSS), and arterial (ATOS). Neurogenic TOS accounts for over 95% of the cases, followed by venous (3–5%) and arterial (1–2%). Neurogenic TOS (NTOS) has been further divided into True NTOS (TNTOS) and Disputed NTOS (DNTOS), with DNTOS reportedly representing 95–99% of all neurogenic cases. In order to decrease confusion and to improve therapeutic results with TOS, the disease should be classified based on the underlying pathologic entity. Acquired and traumatic abnormalities of the clavicle and first rib should be classified separately. Clearly after the more common and objectively supported diagnoses of conditions that result in neurovascular symptoms of the upper extremity, such as cervical spine disease, carpal tunnel disease, and nerve entrapment syndromes, have been ruled out, there remains a group of patients who are suspected of having TOS. In these patients, rather than the more usual classification such as arterial, venous, or neurogenic, the more accurate approach from a diagnostic and therapeutic approach is to classify them as: Cervical Rib Disease: Patients with cervical rib syndrome (CRS) can have complications relating to compression of the subclavian artery (previously referred to as ATOS) and the brachial plexus(previously referred to as True NTOS) secondary to a well-formed cervical rib, or to an incompletely formed first rib, fibrous band associated with a rudimentary cervical rib, or a giant transverse process of C7. Thoracic Outlet Disease or “Subclavian Vein Compression Syndrome”: In these patients an abnormal first rib at its junction with the sternum results in compression of the subclavian vein at the subclavian-innominate junction. Compression of the vein results in venous hypertension in the upper extremity and resultant neurologic symptoms. With prolonged compression of the subclavian-innominate junction, the vein clots giving rise to Paget–Schroetter syndrome. Therefore, patients who have been previously classified as Disputed Neurogenic and Venous TOS represent a variable symptomatic presentation of the same pathologic entity, which affects the subclavian vein. Presently MRA of the thoracic outlet with arm maneuvers is the test of choice in patients suspected of having TOS. This test shows the abnormal bony tubercle on the first rib with extrinsic compression of the subclavian innominate junction, which is exacerbated with elevation of the arm above the shoulder. Robotic resection of the medial aspect of the first rib along with disarticulation of the costo-sternal joint has the best reported results to date.

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Rib Pressure Causing Brachial Plexus Paralysis

Cited by 3 publications

References 0 publications

Robotic first rib resection for thoracic outlet syndrome

Robotic first rib resection for thoracic outlet syndrome

Wasting of the hand associated with a cervical rib or band

Modern Diagnosis and Surgical Management of Thoracic Outlet Syndrome: A Comprehensive Review

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