Gilliatt-Sumner Hand Revisited: A 25-year Experience

Neurosurgery ◽  
2004 ◽  
Vol 55 (4) ◽  
pp. 883-890 ◽  
Author(s):  
Gabriel C. Tender ◽  
Ajith J. Thomas ◽  
Najeeb Thomas ◽  
David G. Kline
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Motor Deficit ◽  
State University ◽  
Spinal Nerves ◽  
Supraclavicular Approach ◽  
Lower Trunk ◽  
Louisiana State University ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Severe Motor ◽  
Anterior Operation

Abstract OBJECTIVE: Thirty-three patients with true neurogenic thoracic outlet syndrome, or Gilliatt-Sumner hand, underwent surgical treatment at Louisiana State University during a 25-year period. This study retrospectively evaluated the outcome referable to pain and motor function in these patients. METHODS: All patients had the typical Gilliatt-Sumner hand, secondary to compression of C8, T1, and/or lower trunk. Nineteen patients underwent an anterior supraclavicular approach, and 15 patients underwent a posterior subscapular approach to the brachial plexus. Nerve action potential recordings showed plexus involvement close to the spine, at the level of the junction of the spinal nerves to the lower trunk. RESULTS: Pain, present in 22 patients, improved in 21. Mild motor deficit improved in 12 of 14 patients. Severe motor deficit improved partially in 14 of 20 patients. CONCLUSION: The diagnosis of true neurogenic thoracic outlet syndrome provides a clear operative indication. Surgical decompression needs to involve the medial portion of the plexus, and especially the spinal nerves. An anterior supraclavicular approach is preferred in most cases. If there is a large cervical rib or there has been a prior anterior operation, then a posterior subscapular approach is indicated.

Neurogenic Thoracic Outlet Syndrome

2018 ◽  
Author(s):  
Pascal Lavergne ◽  
Hélène T. Khuong
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Botulinum Toxin Injection ◽  
Signs And Symptoms ◽  
Nerve Blocks ◽  
Initial Management ◽  
Supraclavicular Approach ◽  
Lower Trunk ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Electrophysiologic Studies

Neurogenic thoracic outlet syndrome is an entrapment neuropathy involving the brachial plexus along its trajectory from the cervical spine to the axilla. Clinical presentation includes cervical and upper extremity pain as well as neurologic signs and symptoms in the lower trunk territory. Radiologic and electrophysiologic studies are helpful adjuncts in correctly identifying the site of compression. Initial management is usually conservative, with medication, physical therapy, nerve blocks, or botulinum toxin injection. Surgery often consists of brachial plexus neurolysis and removal of compression points through the supraclavicular approach. Good outcomes can be expected with careful patient selection, but available literature is of limited quality.

Supraclavicular Approach for Neurogenic Thoracic Outlet Syndrome: Description of a Learning Curve

2020 ◽  
Author(s):  
Nikhil Panda ◽  
William W. Phillips ◽  
Abraham D. Geller ◽  
Stuart Lipsitz ◽  
Yolonda L. Colson ◽  
...  
Keyword(s):  
Learning Curve ◽  
Thoracic Outlet Syndrome ◽  
Supraclavicular Approach ◽  
Neurogenic Thoracic Outlet Syndrome

Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center

2003 ◽  
Vol 98 (5) ◽  
pp. 1005-1016 ◽  
Author(s):  
Daniel H. Kim ◽  
Yong-Jun Cho ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Brachial Plexus ◽  
Gunshot Wounds ◽  
Neurological Status ◽  
Health Sciences ◽  
State University ◽  
Content Type ◽  
Lower Trunk ◽  
Louisiana State University ◽  
Fine Print

Object. Outcomes of 1019 brachial plexus lesions in patients who underwent surgery at Louisiana State University Health Sciences Center during a 30-year period are reviewed in this paper to provide management guidelines. Methods. Causes of brachial plexus lesions included 509 stretches/contusions (50%), 161 plexus tumors (16%), 160 thoracic outlet syndromes (TOSs, 16%), 118 gunshot wounds (12%), and 71 lacerations (7%). Many features of clinical presentation, including prior treatment, patient's neurological status, results of electrophysiological studies, intraoperative findings, and postoperative level of function, were studied. The minimum follow-up period was 18 months and the mean follow-up period was 42 months. Repairs were best for injuries located at the C-5, C-6, and C-7 levels, the upper and middle trunk, the lateral cord to the musculocutaneous nerve, and the median and posterior cords to the axillary and radial nerves. Conversely, results were poor for injuries at the C-8 and T-1 levels, and for lower trunk and medial cord lesions, with the exception of injuries of the medial cord to the median nerve. Outcomes were most favorable when patients were carefully evaluated and selected for surgery, although variables such as lesion type, location, and severity, as well as time since injury also affected outcome. This was true also of TOSs and tumors arising from the plexus, especially if they had not been surgically treated previously. Conclusions. Surgical exploration and repair of brachial plexus lesions is technically feasible and favorable outcomes can be achieved if patients are thoroughly evaluated and appropriately selected.

scholarly journals Case Report: Neurogenic Thoracic Outlet Syndrome Without Electrophysiologic Abnormality

2021 ◽  
Vol 12 ◽  
Author(s):  
Sun Woong Kim ◽  
Duk Hyun Sung
Keyword(s):  
Brachial Plexus ◽  
Ct Angiography ◽  
Clinical Features ◽  
Thoracic Outlet Syndrome ◽  
Imaging Techniques ◽  
Neurovascular Bundle ◽  
Brachial Plexopathy ◽  
Lower Trunk ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Electrophysiologic Studies

Neurogenic thoracic outlet syndrome (N-TOS) is a chronic compressive brachial plexopathy that involves the C8, T1 roots, and/or lower trunk. Medial antebrachial cutaneous (MABC) nerve conduction study (NCS) abnormality is reportedly one of the most sensitive findings among the features of N-TOS. The aim of the present study was to report clinical features, imaging findings, treatment, and prognoses of two N-TOS patients with no abnormalities in electrophysiological studies. Both patients presented with paresthesia of unilateral arm, and examination revealed no neurologic deficits. Electrophysiologic studies including MABC NCS were normal. Computed tomography (CT) angiography and brachial plexus magnetic resonance imaging (MRI) of the patients showed compression and displacement of the neurovascular bundle in the thoracic outlet by causative structures. Due to their sensory symptoms and CT angiography and brachial plexus MRI findings, after excluding other diseases, we diagnosed them with N-TOS. With the development of imaging techniques, more patients presenting with clinical features of lower trunk brachial plexopathy and anomalous structures compressing the neurovascular bundle on imaging studies can be diagnosed with N-TOS, even if electrophysiologic studies including MABC NCS do not show abnormalities.

scholarly journals Supraclavicular Resection of a Cervical Rib Causing Thoracic Outlet Syndrome: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (5) ◽  
pp. E520-E520
Author(s):  
Stephen Shelby Burks ◽  
Erin M Wolfe ◽  
Jang Won Yoon ◽  
Allan D Levi
Keyword(s):  
Brachial Plexus ◽  
Clinical Improvement ◽  
Anterior Approach ◽  
Thoracic Outlet Syndrome ◽  
Cervical Vertebrae ◽  
Cervical Rib ◽  
Rib Resection ◽  
Lower Trunk ◽  
Neurogenic Thoracic Outlet Syndrome

Abstract Presence of a cervical rib results from overdevelopment of the seventh cervical vertebrae.1-3 The cervical rib along with scalene muscles can cause neurogenic thoracic outlet syndrome.4,5 Rib resection is typically done via anterior approach, using either supraclavicular or transaxillary route.6,7 We present an operative video detailing supraclavicular resection of a cervical rib causing neurogenic thoracic outlet syndrome with direct decompression of the lower trunk of the brachial plexus. The patient presented with severe symptoms including hand atrophy. We were able to directly visualize the rib and resect it, along with scalene musculature. We present 3-mo follow-up data noting clinical improvement in neuropathic symptoms.

scholarly journals A modified supraclavicular approach to scalenotomy without first rib resection for the treatment of neurogenic thoracic outlet syndrome

2021 ◽  
pp. 101243
Author(s):  
Parménides Guadarrama-Ortíz ◽  
Ingrid Montes de Oca-Vargas ◽  
André Garibay-Gracián ◽  
José Alberto Choreño-Parra ◽  
César Osvaldo Ruíz-Rivero ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Supraclavicular Approach ◽  
Rib Resection ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
First Rib ◽  
First Rib Resection

scholarly journals Neurogenic Thoracic Outlet Syndrome Reviewed

2020 ◽  
Vol 4 (2) ◽  
pp. 709-714
Author(s):  
Ermira PAJAJ ◽  
Ridvan ALIMEHMETI ◽  
Florian DASHI ◽  
Aiola STOJA ◽  
Arsen SEFERI
Keyword(s):  
Differential Diagnosis ◽  
Clinical Characteristics ◽  
Thoracic Outlet Syndrome ◽  
English Literature ◽  
Treatment Options ◽  
Correct Diagnosis ◽  
Motor Deficit ◽  
Surgical Indications ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Work Up

Neurogenic Thoracic Outlet Syndrome (NTOS) is a rare, but controversial syndrome in relation to its diagnosis, treatment modality, and approaches in case of surgical treatment. In the English literature, there are sparse studies dealing with these aspects. We conducted a PubMed 2000-2017 literature review and found a total of 3953 cases reported with NTOS. The clinical characteristics, etiology, electrophysiological and radiological work-up and treatment options were reviewed and reported. It seems that, as far as surgical indication criteria are concerned, there is a consensus for NTOS in its motor deficit stage and its techniques are generally well established. This review showed that differential diagnosis, radiological, and electrophysiological criteria for correct diagnosis of NTOS are not controversial. However, surgical indications and types of approaches and techniques reflect the surgeon’s affiliation with specialties dealing with NTOS (vascular, plastic, hand, orthopedic or neurosurgeons), and the surgeon’s experience with this specific and rare syndrome.

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