Variations of the Course of the Upper Trunk of the Brachial Plexus and their Clinical Significance for the Thoracic Outlet Syndrome: A Study on 93 Cadavers

2006 ◽  
Vol 72 (2) ◽  
pp. 188-192 ◽  
Author(s):  
Konstantinos Natsis ◽  
Trifon Totlis ◽  
Prokopios Tsikaras ◽  
Nikolaos Anastasopoulos ◽  
Panagiotis Skandalakis ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Clinical Significance ◽  
Surgical Approach ◽  
Thoracic Outlet Syndrome ◽  
Anatomical Variations ◽  
Predisposing Factors ◽  
Scalene Muscle ◽  
Anterior Scalene Muscle

The aim of this study is the recording of the variations of the course of the upper trunk (UT) of the brachial plexus (BP) and their clinical significance for the thoracic outlet syndrome (TOS) and the anesthetic blockade of the BP. Five different anatomical variations of the course of the UT of the BP, in relation to the anterior scalene muscle (ASM), were observed in 24 out of the 186 sides of the 93 cadavers we studied (12.9%). The C5 root was passing anteriorly to the ASM in six cases. The UT was located anteriorly to the ASM in four cases and was perforating the ASM's belly in 12 cases. In one cadaver, the ASM was double and the UT was passing between the two bellies of the double ASM. Finally, in another cadaver, the C5 root was found to be anterior to the anterior scalene muscle, while the C6 root was perforating the ASM's belly. These variations are predisposing factors for the TOS; they cause specific symptomatology and require a different surgical approach in comparison with other causes of the syndrome. Moreover, knowledge of these is important during the performance of the anesthetic blockade of the BP.

RELATO DE CASO: SÍNDROME DO DESFILADEIRO TORÁCICO

2018 ◽  
Vol 5 (3) ◽  
pp. 24-27
Author(s):  
Tatiane Silva Gonçalves ◽  
Raíssa Nunes Bezerra De Sá ◽  
Jéssica Neto Ferreira Pacheco ◽  
Alexis Alison Cardozo Leite ◽  
Pedro Manuel Gonzales Cuellar
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Vascular Complications ◽  
Contributing Factors ◽  
Scalene Muscle ◽  
Insidious Onset ◽  
Analgesic Medication ◽  
Bone Anomalies ◽  
Anterior Scalene Muscle ◽  
Cervical Ribs

RESUMO Introdução: A Síndrome do Desfiladeiro Torácico (SDT) é uma entidade clínica com sintomatologia diversa, decorrente de compressão anormal do plexo braquial, na região do desfiladeiro torácico. Esta compressão é exercida, na maioria das vezes, pelo músculo escaleno anterior, mas pode resultar também da existência de bandas musculofibróticas, alteração da morfologia da primeira costela, costelas cervicais e músculos anômalos. A SDT pode ser classificada nos tipos vascular e neurogênico. Descrição do caso: Paciente, sexo feminino, 27 anos, com quadro de dor e parestesia, há dois anos, de início insidioso, em 4º e 5º quirodáctilos e, posteriormente, com progressão para todo membro superior esquerdo (MSE). Procurou Unidade de Pronto Atendimento, sendo prescrito apenas medicação analgésica. Após três dias, apresentou intensificação da dor, associada a palidez e parestesia de MSE procurando atendimento no Hospital Geral de Palmas. Discussão: A SDT acomete mais mulheres entre 20-50 anos, com vários fatores contribuintes, chegando a limitar as atividades diárias e laborais. O tratamento clínico, frequentemente, é a conduta inicial, procurando aliviar os sintomas. Em geral, o tratamento cirúrgico tem indicação em 15 % dos casos, quando a síndrome é decorrente de anomalias ósseas sintomáticas e complicações vasculares.   Palavras-chave: Síndrome do Desfiladeiro Torácico; Costela Cervical; Plexo Braquial. ABSTRACT Introduction: Thoracic Outlet Syndrome (TOS) is a clinical entity with diverse symptomatology due to abnormal compression of brachial plexus in the thoracic outlet region. This compression is often carried out by the anterior scalene muscle, but it may be a result from the presence of musculofibrotic bands, alteration of the first rib morphology, cervical ribs and anomalous muscles. TOS can be classified into vascular and neurogenic types. Case description: Patient, female, 27 years old, with pain and paresthesia, since two years ago, insidious onset, in 4th and 5th fingers, and later with progression to all left upper limb (LUL). She looked for Emergency Care Unit, and only analgesic medication was prescribed. After three days, she presented pain intensification, associated with pallor and paresthesia of LUL, looking for care at the General Hospital of Palmas. Discussion: The TOS affects more women between 20-50 years old, with several contributing factors, limiting daily activities and work. The clinical treatment, often, is the initial conduct, seeking to relieve symptoms. In general, the surgical treatment is indicated in 15% of cases, when the syndrome is due to symptomatic bone anomalies and vascular complications. Keywords: Thoracic Outlet Syndrome; Cervical Rib; Brachial Plexus.

scholarly journals Bilateral anatomic variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle

2015 ◽  
Author(s):  
Miroslav Radunovic ◽  
Batric Vukcevic ◽  
Marija Abramovic ◽  
Nemanja Vukcevic ◽  
Nemanja Radojevic ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Anatomic Variation ◽  
Scalene Muscle ◽  
Anterior Scalene Muscle

Supraclavicular Brachial Plexus Approach for Excision of C8 Nerve Root Schwannoma: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (5) ◽  
pp. 634-635 ◽  
Author(s):  
Radek P Kindl ◽  
Krunal Patel ◽  
Rikin A Trivedi
Keyword(s):  
Brachial Plexus ◽  
Ring Finger ◽  
Venous Plexus ◽  
Neural Foramen ◽  
Scalene Muscle ◽  
3 Dimensional ◽  
Finger Flexion ◽  
Neck Lump ◽  
Anterior Scalene Muscle

Abstract Brachial plexus tumors are uncommon lesions in young adults. The majority of these are benign peripheral sheath tumors. In this 3-dimensional video, we present a case of a 19-yr-old female who presented to the neurosurgical outpatients with an anterior neck lump. It has been present for months, causing occasional numbness and paraesthesia in the distribution of the left ring finger. There was no objective weakness in finger flexion with normal long flexors reflexes. The cervical spine and supraclavicular brachial plexus were investigated with a magnetic resonance imaging (Gadolinium) scan (Figure 1). It demonstrated 30 × 20 × 20 mm lesion adjacent to the C8 nerve arising from the neural foramen, however, mostly occupying the space lateral to it. The patient was consented for resection of the tumor. This was done via the supraclavicular brachial plexus approach. The brachial plexus nerves were macroscopically demonstrated lateral to the anterior scalene muscle. The intraoperative electrophysiology was used to directly stimulate the nerves, which aided in accurate tracking during the dissection. The tumor was exposed after tracing the C8 nerve deep and medial to the anterior scalene muscle. It was resected down to the foramen, reaching the level of the epidural venous plexus, while C8 was spared. The patient recovered with no neurological deficit. The histopathology confirmed grade 1 schwannoma. Subsequently, there was no radiological follow-up performed. This case demonstrates the surgical dissection of supraclavicular brachial plexus in 3-dimensions while describing the unusual dissection medial to scalenus anterior muscle.

Scalenus Minimus Muscle: Overestimated or Not? An Anatomical Study

2013 ◽  
Vol 79 (4) ◽  
pp. 372-374 ◽  
Author(s):  
Konstantinos Natsis ◽  
Trifon Totlis ◽  
Matthaios Didagelos ◽  
George Tsakotos ◽  
Konstantinos Vlassis ◽  
...  
Keyword(s):  
Literature Review ◽  
Thoracic Outlet Syndrome ◽  
Brachial Plexus Block ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Interscalene Brachial Plexus Block ◽  
Scalene Muscle ◽  
Wide Range ◽  
High Incidence ◽  
Plexus Block

The wide range of scalenus minimus muscle incidence reported in the literature along with the plethora of fibromuscular structures that may appear in the interscalene triangle, having various terminologies, were the reasons to conduct the present study questioning the reported high incidence of this supernumerary scalene muscle. Seventy-three Greek cadavers were dissected and examined for the presence of a scalenus minimus muscle. It was found unilaterally in three of 73 (4.11%) cadavers studied. The literature review, concerning its incidence, revealed a wide range between 7.8 and 71.7 per cent, which cannot be attributed only to racial variation. Thus, there is a matter whether other variations of the scalene muscles are considered as a true scalenus minimus muscle. Recognition of this muscle is important not only for anatomists, but also has clinical significance for the diagnosis of the thoracic outlet syndrome. Surgeons performing scalenectomy and anesthesiologists during interscalene brachial plexus block should keep in mind the anatomical variations of this region.

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