Thoracic outlet syndrome surgery causing severe brachial plexopathy

Abstract

Hundreds of first rib resections are performed yearly in the United States to treat a controversial type of neurogenic thoracic outlet syndrome (NTOS). This surgery was thought to be devoid of serious neurological complications until 1982. However, that year Dale unearthed the rather astounding fact that the members of a single surgical society were aware of nearly 300 brachial plexus injuries resulting in motor deficits that had occurred during such operations, although almost none had been reported in the literature. In this report the features of the two main types of NTOS ("true" and "disputed") are discussed. The history of brachial plexus injury occurring during TOS surgery is traced back to the late nineteenth century. The clinical and electrophysiological features of eight patients who sustained such injuries are described in detail, the literature on this topic is reviewed, and the location and causes for these injuries are discussed.

True neurogenic thoracic outlet syndrome: Electrophysiological diagnosis in six cases

“…5,7,17,19 The condition is more common in women than in men (9/1), and age at onset ranges from the second to the eighth decade, with a peak in the fourth decade. 7 All patients with true neurogenic TOS syndrome present bony abnormalities of the lower part of the cervical spine.…”

The thoracic outlet syndrome: Controversies, overdiagnosis, overtreatment, and recommendations for management

“…"x The core of these controversial subjects is the fact that first rib resections are frequently recommended to relieve symptoms which, in a large number of patients, are due to clinical entities other than those producing a neurovascular compression at the thoracic outlet. 16, 44 Although many surgeons repeatedly stress the value of a first rib resection in selected cases, the nonspecific neurogenic TOCS continues to be the source of misdiagnosis and poor patient selection. A safeguard against misdiagnosis of the syndrome is to advise patients suspected of having nonspecific neurogenic TOCS that other correctable lesions must be excluded first.…”

Síndrome do desfiladeiro torácico tipo neurogênico verdadeiro: relato de dois casos

“…Estudos neurofisiológicos devem ser realizados em pacientes com suspeita de SDT neurogênico inespecífico primariamente para excluir compressão de nervos em locais mais distais que o desfiladeiro torácico, como por exemplo a compressão a nível de túnel do carpo 13 . Embora não haja estatística brasileira, nos Estados Unidos muitos pacientes continuam sendo diagnosticados como tendo SDT neurogênico inespecífico e sendo submetidos a cirurgia de ressecção da primeira costela, que tem eficácia a longo prazo muito pequena, semelhante ao tratamento conservador [19][20][21][22] . O tratamento conservador inclui exercícios e fisioterapia para melhorar a postura dos pacientes, reforçar a cintura escapular e melhorar a função da coluna cervical 22 e educação do paciente para evitar posturas anormais, como a cabeça posicionada anteriormente ao tronco, abdução da escápula e rotação interna do ombro 23 .…”