Anatomically Complete Supraclavicular Reoperation for Recurrent Neurogenic Thoracic Outlet Syndrome: Clinical Characteristics, Operative Findings, and Long-term Outcomes

Hand ◽  
2021 ◽  
pp. 155894472098807
Author(s):  
Momodou L. Jammeh ◽  
J. Westley Ohman ◽  
Chandu Vemuri ◽  
Ahmmad A. Abuirqeba ◽  
Robert W. Thompson
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Length Of Hospital Stay ◽  
Functional Improvement ◽  
Scalene Muscle ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
First Rib ◽  
Previous Operation ◽  
Combined Operations ◽  
The Mean ◽  
Operative Findings

Background: The clinical outcomes of reoperations for recurrent neurogenic thoracic outlet syndrome (NTOS) remain undefined. Methods: From 2009 to 2019, 90 patients with recurrent NTOS underwent anatomically complete supraclavicular reoperation after previous operation(s) performed at other institutions using either supraclavicular (Prev-SC = 48), transaxillary (Prev-TA = 31), or multiple/combination (Prev-MC = 11) approaches. Prospectively maintained data were analyzed retrospectively. Results: The mean patient age was 39.9 ± 1.4 years, 72% were female, and the mean interval after previous operation was 4.1 ± 0.6 years. The mean Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 62 ± 2, reflecting substantial preoperative disability. Residual scalene muscle was present in 100% Prev-TA, 79% Prev-SC, and 55% Prev-MC ( P < .05). Retained/residual first rib was present in 90% Prev-TA, 75% Prev-SC, and 55% Prev-MC ( P < .05). There were no differences in operative time (overall 210 ± 5 minutes), length of hospital stay (4.7 ± 0.2 days), or 30-day readmissions (7%). During follow-up of 5.6 ± 0.3 years, the improvement in QuickDASH scores was 21 ± 2 (36% ± 3%) ( P < .01) and patient-rated outcomes were excellent in 10%, good in 36%, fair in 43%, and poor in 11%. Conclusions: Anatomically complete decompression for recurrent NTOS can be safely and effectively accomplished by supraclavicular reoperation, regardless of the type of previous operation. Residual scalene muscle and retained/residual first rib are more frequently encountered after transaxillary operations than after supraclavicular or multiple/combined operations. Supraclavicular reoperation can achieve significant symptom reduction and functional improvement for approximately 90% of patients with recurrent NTOS.

scholarly journals A Novel Approach to First-Rib Resection in Neurogenic Thoracic Outlet Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Yueying Li ◽  
Yanxi Liu ◽  
Zhan Zhang ◽  
Xuehai Gao ◽  
Shusen Cui
Keyword(s):  
Postoperative Complications ◽  
Patient Group ◽  
Thoracic Outlet Syndrome ◽  
Operative Time ◽  
Conventional Group ◽  
Rib Resection ◽  
Surgery Group ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
First Rib ◽  
First Rib Resection

Objectives: The treatment for neurogenic thoracic outlet syndrome (NTOS) conventionally involves first-rib resection (FRR) surgery, which is quite challenging to perform, especially for novices, and is often associated with postoperative complications. Herein, we report a new segmental resection approach through piezo surgery that involves using a bone cutter, which can uniquely provide a soft tissue protective effect.Methods: This retrospective study involved the examination of 26 NTOS patients who underwent piezo surgery and another group of 30 patients who underwent FRR using the conventional technique. In the patient group that underwent piezo surgery, the rib was first resected into two pieces using a piezoelectric device and subsequently removed. In the patient group that underwent conventional surgery, the first rib was removed as one piece using a rib cutter and rongeurs.Results: The piezo surgery group had significantly shorter operative time (96.85 ± 14.66 vs. 143.33 ± 25.64 min, P &lt; 0.001) and FRR duration (8.73 ± 2.11 vs. 22.23 ± 6.27 min, P &lt; 0.001) than the conventional group. The posterior stump length of the residual rib was shorter in the piezo surgery group than in the conventional group (0.54 ± 0.19 vs. 0.65 ± 0.15 cm, P &lt; 0.05). There were no significant differences in postoperative complications and scores of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Cervical Brachial Symptom Questionnaire (CBSQ), and the visual analog scale (VAS). Even the TOS index (NTOS Index = [DASH + (0.83 × CBSQ) + (10 × VAS)]/3) and patient self-assessments of both the groups showed no significant differences. Univariate analyses indicated that the type of treatment affected operative time.Conclusion: Our results suggest that piezo surgery is safe, effective, and simple for segmental FRR in NTOS patients. Piezo surgery provides a more thorough FRR without damaging adjacent soft tissues in a relatively short duration and achieves similar functional recovery as conventional techniques. Therefore, piezo surgery can be a promising alternative for FRR during the surgical treatment of NTOS.

scholarly journals Impact of Scalene Muscle Botulinum Toxin Injection with and without Surgery in Neurogenic Thoracic Outlet Syndrome

2021 ◽  
Vol 74 (4) ◽  
pp. e410
Author(s):  
Arash Fereydooni ◽  
Vy T. Ho ◽  
Emily Miller Olson ◽  
Paige Dyrek ◽  
Taylor Harris ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Thoracic Outlet Syndrome ◽  
Botulinum Toxin Injection ◽  
Scalene Muscle ◽  
Neurogenic Thoracic Outlet Syndrome

Arterial Complications of Thoracic Outlet Syndrome

2009 ◽  
Vol 75 (3) ◽  
pp. 235-239 ◽  
Author(s):  
Lazar B. Davidović ◽  
Igor B. Končar ◽  
Siniša D. Pejkić ◽  
Ilija B. Kuzmanović
Keyword(s):  
Subclavian Artery ◽  
Complete Resolution ◽  
Thoracic Outlet Syndrome ◽  
Clavicle Fracture ◽  
Distal Embolization ◽  
Cervical Rib ◽  
First Rib ◽  
Arterial Complications ◽  
The Mean

Arterial complications of thoracic outlet compression have serious potential implications; however, these complications rarely appear. Between 1990 and 2006, prospectively collected data on 27 patients with arterial complications of thoracic outlet syndrome were analyzed. The causes of arterial compression were cervical rib (20 [74.1%]), abnormalities of the first thoracic rib (three [11.1%]), soft tissue anomalies (two [7.4%]), and hypertrophic callus after clavicle fracture (two [7.4%]). In all cases, a combined supraclavicular and infraclavicular approach was used. Decompression was achieved by cervical rib excision in 13 (48.1%) patients, combined cervical and first rib excision in seven (26%), and first rib excision in six (22.2%). Associated vascular procedures included resection and replacement of the subclavian artery (26 [97.3%]), one subclavian–axillary and one axillary–brachial bypass as well as 17 (63%) brachial embolectomies. The mean follow-up period was 7 years 4 months (range, 1-16 years). Two pleural entries, two transient brachial plexus injuries, and one subclavian artery rethrombosis were found. Complete resolution of symptoms with a return to full activity was noted in all cases. In surgical treatment, a combined anterior supraclavicular and infraclavicular approach is recommended as well as transbrachial embolectomy in all cases with symptoms of distal embolization.

scholarly journals Hand Strength Deficit in Patients with Neurogenic Thoracic Outlet Syndrome

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 874
Author(s):  
Alban Fouasson-Chailloux ◽  
Pauline Daley ◽  
Pierre Menu ◽  
Bastien Louguet ◽  
Guillaume Gadbled ◽  
...  
Keyword(s):  
Grip Strength ◽  
Upper Limb ◽  
Healthy Subjects ◽  
Thoracic Outlet Syndrome ◽  
Hand Strength ◽  
Diagnostic Process ◽  
Healthy Controls ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Hand Dynamometer ◽  
The Mean

Neurogenic thoracic outlet syndrome (NTOS) is a chronic painful and disabling condition. Patients complain about upper-limb paresthesia or weakness. Weakness has been considered one of the diagnostic criteria of NTOS, but objective comparisons to healthy controls are lacking. We compared the grip and the key pinch strengths between NTOS patients and healthy controls. Grip strength was evaluated with a hydraulic hand dynamometer and the key pinch with a pinch gauge. All the patients with NTOS completed a QuickDASH. We included prospectively 85 patients with NTOS, 73% female and 27% male. The mean age was 40.4 ± 9.6. They were compared to 85 healthy subjects, 77.6% female and 22.4% male. Concerning the grip, symptomatic hands of NTOS patients had significantly 30% less strength compared to control hands (p ≤ 0.001), and 19% less strength compared to asymptomatic hands (p = 0.03). Concerning the key pinch, symptomatic hands of patients with NTOS had significantly 19.5% less strength compared to control hands (p ≤ 0.001). Grip and key pinch strengths had a significant correlation with the QuickDASH (r = −0.515 and r = −0.403, respectively; p ≤ 0.001). Patients with NTOS presented an objective hand strength deficit compared to healthy controls. This deficit was significantly correlated to the upper-limb disability. These findings confirm the interest of hand strength evaluation in the diagnostic process of patients with NTOS.

scholarly journals Role of Scalene Muscle Block in Selecting Operative Candidates Among Patients with Neurogenic Thoracic Outlet Syndrome

2021 ◽  
Vol 73 (1) ◽  
pp. e30-e31
Author(s):  
Celso F. Uribe ◽  
Peyton Terry ◽  
Bernadette Frederick Goudreau ◽  
John A. Kern ◽  
Thomas Gianis ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Scalene Muscle ◽  
Neurogenic Thoracic Outlet Syndrome
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