Venous pectoralis minor syndrome: a rare subdivision of the thoracic outlet syndrome

Abstract

We analysed data of all patients who had received surgery for rare, isolated venous pectoralis minor syndrome at our tertiary institution from January 2015 to December 2018. Venous duplex scan was the preferred mode of diagnosis in all our patients. We operated on patients via a 5–6 cm deltopectoral groove incision. Ten procedures were performed on 6 patients, of whom 5 were female. The median age was 23 years (range 17–33 years). Three patients (2 female, 1 male) with bilateral pectoralis minor syndrome had separate procedures performed over a course of a few weeks. The median operating time was 22 min (range 15–95 min). Median blood loss was 20 ml (range 5–410 ml). The median hospital stay was 2 days (range 1–5 days). There was one complication in the form of a recurrence on the right side in a patient who had bilateral pectoralis minor syndrome. No other morbidities were recorded. Nine of 10 procedures (90%) were classified by patients as being satisfactory, where symptoms had partially or completely resolved. Our experience emphasizes the need for a systematic search and to maintain a high index of suspicion for venous pectoralis minor syndrome in all patients complaining of painful symptoms related to thoracic outlet syndrome. The deltopectoral groove approach is a simple and straightforward incision with a gentle learning curve.

Pectoralis minor syndrome

“…[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.…”

“…[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.…”

“…Compression above the clavicle, occurs in the interscalene triangle and costoclavicular area, producing TOS; below the clavicle, compression occurs in the PM space, producing PMS. [2,3] In general, neural structures are more affected than vascular structures. Sanders and Annest [1] reported more than 90% of cases involving BP, 5% involving venous obstruction, and 1% associated with arterial obstruction in TOS.…”

“…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.…”

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

“…Those who fail physical therapy or have vascular compression can be successfully treated with relatively risk-free nerve blocks or PM tenotomies, thereby avoiding more invasive thoracic outlet operations and their potential complications. [1][2][3] Over 90% of patients with isolated PMS have resolution of symptoms with tenotomy, whereas about 35% of patients with PMS and TOS require both tenotomy and thoracic outlet surgery. 2 Patients A and B underwent PM tenotomy with symptom improvement.…”