Our Surgical Strategy for Thoracic Outlet Syndrome

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Yasuhiro Nakajima
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Vascular Compression ◽  
Compression Tests ◽  
Provocation Tests ◽  
Diagnosis Method ◽  
Tunnel Syndrome ◽  
Electrophysiological Examination ◽  
Sensory Neural ◽  
Plexus Block

Surgical treatment for thoracic outlet syndrome (TOS) is a very controversial surgery because objective diagnosis, such as image and electrophysiological examination, is very difficult. Clinical provocation tests including brachial plexus compression tests, such as Morley and Roos, and vascular compression tests, such as Wright and Eden ,are not high in specificity and are likely to be positive even in healthy persons and patients with carpal tunnel syndrome. We place emphasis on the laterality of latency and amplitude in the sensory neural action potential (SNAP) of the medial antebrachial cutaneous nerve and ulnar nerve. After enough stretching exercises of scapular stabilizers and brachial plexus block, we always select surgery. In this presentation, I would like to show our diagnosis method and treatment strategy including surgery.

Our Surgical Strategy for Thoracic Outlet Syndrome

2018 ◽  
Vol 1 (2) ◽  
pp. 32
Author(s):  
Yasuhiro Nakajima
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Vascular Compression ◽  
Compression Tests ◽  
Provocation Tests ◽  
Diagnosis Method ◽  
Tunnel Syndrome ◽  
Electrophysiological Examination ◽  
Sensory Neural ◽  
Plexus Block

Surgical treatment for thoracic outlet syndrome (TOS) is a very controversial surgery because objective diagnosis, such as image and electrophysiological examination, is very difficult. Clinical provocation tests including brachial plexus compression tests, such as Morley and Roos, and vascular compression tests, such as Wright and Eden ,are not high in specificity and are likely to be positive even in healthy persons and patients with carpal tunnel syndrome. We place emphasis on the laterality of latency and amplitude in the sensory neural action potential (SNAP) of the medial antebrachial cutaneous nerve and ulnar nerve. After enough stretching exercises of scapular stabilizers and brachial plexus block, we always select surgery. In this presentation, I would like to show our diagnosis method and treatment strategy including surgery. 

scholarly journals Neurogenic Thoracic Outlet Syndrome Caused by Vascular Compression of the Brachial Plexus: A Report of Two Cases

2018 ◽  
Vol 13 (01) ◽  
pp. e1-e3
Author(s):  
Amgad Hanna ◽  
Larry Bodden ◽  
Gabriel Siebiger
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Vascular Compression ◽  
Repetitive Motion ◽  
Physical Trauma ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Inferior Portion ◽  
Pass Through ◽  
Neurogenic Tos

AbstractThoracic outlet syndrome (TOS) is caused by compression of the brachial plexus and/or subclavian vessels as they pass through the cervicothoracobrachial region, exiting the chest. There are three main types of TOS: neurogenic TOS, arterial TOS, and venous TOS. Neurogenic TOS accounts for approximately 95% of all cases, and it is usually caused by physical trauma (posttraumatic etiology), chronic repetitive motion (functional etiology), or bone or muscle anomalies (congenital etiology). We present two cases in which neurogenic TOS was elicited by vascular compression of the inferior portion of the brachial plexus.

Case 13

2018 ◽  
Author(s):  
Bashar Katirji
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Brachial Plexus ◽  
Carpal Tunnel ◽  
Thoracic Outlet Syndrome ◽  
Median Sternotomy ◽  
Cubital Tunnel Syndrome ◽  
Brachial Plexopathy ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Tunnel Syndrome ◽  
Neurogenic Disorder

Thoracic outlet syndrome remains a controversial syndrome despite being described more than a century ago. This syndrome has neurogenic, vascular, and disputed types. True neurogenic thoracic outlet syndrome is relatively rare syndrome often associated with a cervical rib or cervical band. Symptoms include pain, hand and forearm numbness, and hand weakness and atrophy. The true neurogenic disorder has classical electrodiagnostic presentations. This case highlights the anatomy of the brachial plexus and distinguishes true neurogenic thoracic outlet syndrome from carpal tunnel syndrome, cubital tunnel syndrome, C8 radiculopathy, T1 radiculopathy, and post-median sternotomy brachial plexopathy, with emphasis on the electrodiagnostic findings.

Double Crush Syndrome Related to the Thoracic Outlet Syndrome

Hand Surgery ◽  
1997 ◽  
Vol 02 (02) ◽  
pp. 131-133 ◽  
Author(s):  
Jun Nishida ◽  
Katsuaki Ichinohe ◽  
Tadashi Shimamura ◽  
Masataka Abe
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Thoracic Outlet Syndrome ◽  
Cubital Tunnel Syndrome ◽  
Entrapment Neuropathy ◽  
Cubital Tunnel ◽  
Provocation Tests ◽  
Tunnel Syndrome ◽  
Double Crush ◽  
Ulnar Tunnel

Cases diagnosed as having thoracic outlet syndrome were examined by neurological examination, including provocation tests, electromyography and radiological examinations, to detect other sites of entrapment neuropathy of the upper extremity. During the last four years, 555 upper extremities of 494 patients were diagnosed as having thoracic outlet syndrome. Forty-five patients (9.3%) were diagnosed as having other entrapment neuropathy in one extremity. Ten cases were complicated by cervical radiculopathy, 15 by carpal tunnel syndrome, 11 by cubital tunnel syndrome, five by radial tunnel syndrome, two by ulnar tunnel syndrome, two by both carpal tunnel and cubital tunnel syndrome, and one by both cubital and ulnar tunnel syndrome. Surgery was performed for 15 limbs, and the distal lesion was operated on the first in two-thirds of these patients. The relationship between thoracic outlet syndrome and cubital tunnel syndrome or carpal tunnel syndrome has been reported by several authors, but the rates of incidence vary among reports. The rate of incidence seems to depend upon the diagnostic technique. After adoption of the appropriate provocation tests, patients with thoracic outlet syndrome complicated by other entrapment neuropathies were detected at a relatively high rate of incidence. Provocation tests seem to be an essential measure for the diagnosis of double crush syndromes.

scholarly journals Comparison of ultrasound and electrical neurostimulation guidance in axillary brachial plexus block

2020 ◽  
pp. 50-53
Author(s):  
Omur Ozturk ◽  
Ali Bilge ◽  
Aysu Hayriye Tezcan ◽  
Hatice Yagmurdur ◽  
Gokhan Ragıp Ulusoy ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Brachial Plexus ◽  
Motor Block ◽  
Ultrasound Guidance ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Axillary Brachial Plexus Block ◽  
Tunnel Syndrome ◽  
Plexus Block ◽  
Better Than

Objectives: To compare ultrasound guidance (USG) and electrical neurostimulation guidance (ENSG) in axillary brachial plexus block in terms of block performing time, sensory and motor block quality, and patient satisfaction. Methodology: 200 patients undergoing elective carpal tunnel syndrome surgery were randomly assigned to one of two groups; the USG group or the ENSG group. Axillary blocks were performed with a mixture of 15 ml of lidocaine 2% and 15 ml of bupivacaine 0.5% (a total of 30 ml solution). Sensory block was evaluated with a pinprick test and motor block was evaluated via the Bromage scale by a blinded observer. Results: Block performing time was significantly shorter in the USG group than in the ENSG group (P<0.001). The sensory and motor block onset times were significantly shorter and the additional analgesic requirements were significantly lower in the USG group than in the ENSG group (P<0.001). Conclusion: USG is better than ENSG in axillary brachial plexus block in terms of block performing time, block quality and patient satisfaction. Citation: Ozturk O, Bilge A, Tezcan AH, Tezcan HYAH, Ulusoy GR, Gezgin I, Dost B. Comparison of ultrasound and electrical neurostimulation guidance in axillary brachial plexus block. Anaesth Pain & Intensive Care 2016;20(1):50-53.

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