Histopathological basis for neurogenic thoracic outlet syndrome

2008 ◽  
Vol 8 (4) ◽  
pp. 347-351 ◽  
Author(s):  
R. Shane Tubbs ◽  
Robert G. Louis ◽  
Christopher T. Wartmann ◽  
Robert Lott ◽  
Gina D. Chua ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Immunohistochemical Analysis ◽  
Histopathological Changes ◽  
Histological Findings ◽  
Histological Changes ◽  
Cervical Rib ◽  
Lower Trunk ◽  
Human Cadavers ◽  
Cervical Ribs

Object To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression. Methods Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42%) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs. Results The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified. Conclusions Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.

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 Cervical Rib Surgery: A Study of 20 Cases

1970 ◽  
Vol 17 (1) ◽  
pp. 10-12 ◽  
Author(s):  
M Lutfor Rahman ◽  
G Mohammod ◽  
I Alam ◽  
MS Ali
Keyword(s):  
Upper Limb ◽  
Thoracic Outlet Syndrome ◽  
Small Study ◽  
Fibrous Band ◽  
Private Hospitals ◽  
Cervical Rib ◽  
Orthopedic Surgeon ◽  
Diagnosis And Management ◽  
Initial Surgery ◽  
Cervical Ribs

Cervical ribs give rise to vascular and neurogenic manifestation in the upper limb due to stretching and friction of neurovascular bundle in the base of the neck by numerous mechanisms that includes cervical ribs, anomalous ligament & hypertrophy of the scalenus anticus muscle. Controversy surrounds the diagnosis and management of thoracic outlet syndrome with or without cervical ribs. This is a small study of 20 cases carried out from 1994 to 2003 at RMCH, and some private hospitals. Out of them, 15 patients (75%) were male and 5 patients (25%) were female. The age of the patients was between 15 to 48 years (mean age 33 years) Unilateral cervical ribs were present in 75% cases and the rest 25% had bilateral cervical ribs. Only 3 patients presented with gangrenous upper limb. One of the patient attended to orthopedic surgeon first and amputation was planned. All the patient were treated through supra clavicular approach by excision of cervical ribs together with fibrous band. Only one patient did not respond to this initial surgery as symptoms persist and re-operation done by excision of first-rib and ultimately that patient become symptom free. In this study, authors explained their own experience of various way of presentation of cervical ribs, aetiology, different modalities of the treatment and their out come.     doi: 10.3329/taj.v17i1.3482 TAJ 2004; 17(1) : 10-12  

Undiagnosed bilateral complete cervical rib with subclavian artery aneurysm presenting as acute ischaemic limb following high-altitude expedition

2021 ◽  
Vol 14 (2) ◽  
pp. e241194
Author(s):  
Raja Lahiri ◽  
Udit Chauhan ◽  
Ajay Kumar ◽  
Nisanth Puliyath
Keyword(s):  
High Altitude ◽  
Subclavian Artery ◽  
Thoracic Outlet Syndrome ◽  
Artery Aneurysm ◽  
Limb Ischaemia ◽  
Cervical Rib ◽  
Subclavian Artery Aneurysm ◽  
Acute Limb Ischaemia ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs

Arterial thoracic outlet syndrome is relatively rare and often exclusively seen in the presence of bony anomalies. High-altitude (HA) travel is commonly associated with thrombosis; however, arterial thromboembolism is less frequently described. We describe a case of a young man with undiagnosed bilateral cervical rib, who went for an HA trek, subsequent to which developed acute limb ischaemia of right arm. Diagnostic workup revealed a subclavian artery aneurysm as well along with complete bony bilateral cervical ribs. Thoracic outlet syndrome should be kept as a differential diagnosis in a case of acute limb ischaemia in a healthy adult.

scholarly journals Harvey Cushing’s management of neurogenic thoracic outlet syndrome

2019 ◽  
Vol 130 (3) ◽  
pp. 712-715
Author(s):  
Courtney Pendleton ◽  
Allan J. Belzberg ◽  
Robert J. Spinner ◽  
Alfredo Quinones-Hinojosa
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Johns Hopkins Hospital ◽  
Single Patient ◽  
Detailed Review ◽  
Cervical Rib ◽  
Harvey Cushing ◽  
Operative Report ◽  
Nerve Surgery

Harvey Cushing is widely regarded as one of the forefathers of neurosurgery, and is primarily associated with his work on intracranial pathology. However, he had a clinical and academic interest in peripheral nerve surgery. Through the courtesy of the Alan Mason Chesney Medical Archives, the surgical records of the Johns Hopkins Hospital from 1896 to 1912 were reviewed. The records of a single patient undergoing brachial plexus exploration and cervical rib resection were selected for detailed review. The operative report and accompanying illustrations demonstrate Cushing’s interest in adding approaches to the pathology of the brachial plexus to his operative armamentarium.

scholarly journals Articulating Cervical Rib - A Culprit Often Overlooked on Imaging! : Review Article

2021 ◽  
Vol 11 (9) ◽  
pp. 230-236
Author(s):  
Pratik S. Itti ◽  
Sharad B. Ghatge ◽  
Shraddha Somani
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Tertiary Care ◽  
Case Series ◽  
Arterial Occlusion ◽  
Radiographic Examination ◽  
Main Body ◽  
Care Hospital ◽  
Cervical Rib ◽  
Arterial Complications ◽  
Cervical Ribs

Background: Cervical rib, though it is seen incidentally in the radiographic examination of chest and cervical spine, a particular subset of it can present with thoracic outlet syndrome. This article mainly focuses on the symptom causation of articulating cervical rib, as compared to non-articulating cervical rib which is often asymptomatic. There are many articles describing a cervical rib, but those highlighting this particular relation between the types of cervical rib and symptom causation are not present in present database. The review of serial radiographs upon correlating clinically, lead us to conclude that articulating variant of cervical rib is majorly symptomatic and caused grave arterial complications. The article consists brief discussions on the types of cervical ribs, thoracic outlet syndrome and role of imaging in diagnosing a cervical rib. Main Body: We have illustrated five such cases from our tertiary care hospital and highlighted the relationship between the magnitude of symptoms and variations of cervical rib. In compliance with PRISMA guidelines, we screened 33 articles dealing with cervical rib and 13 with thoracic outlet syndrome. Overall, 46 articles were filtered on studying the abstract. Further, 15 more had to be excluded as they were case reports and case series, and finally 31 articles were included in our study. We studied and discussed these articles and research papers in relation to variant anatomy of cervical rib, its types and symptom causation. In our study, also routine sequential chest radiographs were reviewed during the period of January 2020 to January 2021 and those with cervical rib and/or elongated C7 transverse process were included. Conclusion: Thus, to conclude we can state that articulating cervical ribs pose a greater threat and cause arterial occlusion. Key words: Cervical rib, thoracic outlet syndrome, subclavian artery.

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.

Posterior Subscapular Approach to the Brachial Plexus

2005 ◽  
Vol 57 (suppl_4) ◽  
pp. ONS-377-ONS-381 ◽  
Author(s):  
Gabriel C. Tender ◽  
David G. Kline
Keyword(s):  
Morbid Obesity ◽  
Brachial Plexus ◽  
Operative Technique ◽  
Thoracic Outlet Syndrome ◽  
Transverse Process ◽  
Senior Author ◽  
Anterior Neck ◽  
Spinal Nerves ◽  
Cervical Rib ◽  
The Past

Abstract THE POSTERIOR SUBSCAPULAR APPROACH to the brachial plexus is commonly indicated in patients with neural entrapment (neurogenic thoracic outlet syndrome, especially when associated with a large C7 transverse process or cervical rib) and paraspinal tumors or lacerating injuries involving the spinal nerves close to the spine. This approach is also preferred in patients with previous anterior neck operations and/or morbid obesity. We describe the anatomy and operative technique of this approach, which has been used by the senior author (DGK) for the past 25 years.

scholarly journals A Never Described Variant of the Cervical Rib Causing Arterial Thoracic Outlet Syndrome: World's First Case

2021 ◽  
Vol 07 (03) ◽  
pp. e179-e183
Author(s):  
Saif Abdeali A. Kaderi ◽  
Pravin Shinde ◽  
Raviraj Tilloo ◽  
Sonewane Chetan ◽  
Tanvi Dalal ◽  
...  
Keyword(s):  
Oral Anticoagulation ◽  
Thoracic Outlet Syndrome ◽  
Transverse Process ◽  
Rest Pain ◽  
Postoperative Course ◽  
Cervical Rib ◽  
Artery Thrombosis ◽  
First Case ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs

AbstractCervical ribs, also known as Eve's ribs, are rare and found in 1% of population. They are more common in females and more common on right side. They are asymptomatic in 90% of cases. Cervical rib fused with transverse process of sixth vertebra is rarer. We present a case of dry gangrene of lateral three fingers with right radial and subclavian artery thrombosis with rest pain, due to right cervical rib fused with transverse process of sixth vertebra. After development of line of demarcation of the dry gangrene, patient was operated for excision of cervical rib and sixth cervical vertebral transverse process followed by Ray's amputation of right second finger. Postoperative course was uneventful. Patient was discharged with oral anticoagulation and a healthy wound in right hand.

Sign in / Sign up

Export Citation Format

Share Document