Anatomic Variation of the Phrenic Nerve and Brachial Plexus Encountered during 100 Supraclavicular Decompressions for Neurogenic Thoracic Outlet Syndrome with Associated Postoperative Neurologic Complications

Golarz, Scott R.; White, Joseph

doi:10.1016/j.avsg.2019.04.010

Cited by 12 publications

(7 citation statements)

References 6 publications

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“…It may receive branches from various origins including the brachial plexus, spinal accessory nerve or the hypoglossal nerve. Additionally, about 30% of the phrenic nerve pathways are variants of the standard anatomy 27 . Also accessory phrenic nerve may arise from either the brachial plexus, nerve to subclavius, or the cervical plexus such as supraclavicular nerve and ansa cervicalis.…”

Section: Discussionmentioning

confidence: 99%

Hemidiaphragmatic paralysis following costoclavicular versus supraclavicular brachial plexus block: a randomized controlled trial

Hong

Lee

et al. 2021

Sci Rep

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Costoclavicular brachial plexus block is emerging as a promising infraclavicular approach performed just below the clavicle. However, there are relatively little data regarding the hemidiaphragmatic paralysis (HDP) compared to the commonly performed supraclavicular block. We hypothesized that the incidence of HDP in costoclavicular block is lower than supraclavicular block like classical infraclavicular approach. Eighty patients were randomly assigned to ultrasound-guided supraclavicular (group S) or costoclavicular (group C) block with 25 mL of local anesthetics (1:1 mixture of 1% lidocaine and 0.75% ropivacaine). The primary outcome was the incidence of HDP, defined as less than 20% of fractional change in the diaphragm thickness on ultrasound M-mode. Also, pulmonary function test and chest radiograph were assessed before and after the surgery. The incidence of HDP was 4/35 (11.4%) in the group C and 19/40 (47.5%) in the group S (risk difference, − 36%; 95% CI − 54 to − 17%; P = 0.002). The mean (SD) change of DTF values were 30.3% (44.0) and 56.9% (39.3) in the group C and S, respectively (difference in means, − 26.6%; 95% CI − 45.8 to − 7.4%; P = 0.007). The pulmonary function was more preserved in group C than in group S. The determined diagnostic cut off value of the diaphragm elevation on chest radiograph was 29 mm. Despite the very contiguous location of the two approaches around the clavicle, costoclavicular block can significantly reduce the risk of HDP compared with supraclavicular block.

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Section: Discussionmentioning

confidence: 99%

Hemidiaphragmatic paralysis following costoclavicular versus supraclavicular brachial plexus block: a randomized controlled trial

Hong

Lee

et al. 2021

Sci Rep

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“…Considerable variation of the standard anatomy of the PN in the neck has not been extensively described in the literature. Interestingly, frequent PN variation occurs in patients with supraclavicular decompression surgery for neurogenic thoracic outlet syndrome; however, there are few reports based on cadaver research [3]. In this report, anatomic variations of the PN were identified in 28 (28%) patients with duplicated PNs, accessory PN, and medially or laterally displaced PNs.…”

Section: Discussionmentioning

confidence: 62%

“…Unilateral diaphragmatic paralysis is frequently caused by an iatrogenic injury due to the anatomical variants of the PN that are encountered during thorax and neck procedures, including surgical, anaesthetic, or chiropractic complications [10,19]. There are several anatomical variants of the PN that have been described; however, most are related to the duplication of the PN, as well as medial and lateral deviations of the PN [3]. Duplication of the PN is associated with early developmental events of the nascent diaphragm [20,22], while aberrant origin and course of the thyrocervical trunk (TCT) arising in the SCA are thought to be the causes of deviations of the PN [16].…”

Section: Introductionmentioning

confidence: 99%

An unusual anatomical variant of the left phrenic nerve encircling the transverse cervical artery

et al. 2021

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“…The phrenic nerve classically arises from the C4 nerve root with contributions of the C3 and C5 nerve roots and allows for breathing by supplying the ipsilateral diaphragmatic musculature. 26 Because of the circumstances surrounding hemidiaphragmatic paralysis, direct needle injury may have been a cause of phrenic nerve damage in our patient. The phrenic nerve, as it passes laterally in the cervical spine and in the craniocaudal direction, could have easily been injured or transected by the needle, especially with the transforaminal approach.…”

Section: Discussionmentioning

confidence: 76%

Right hemidiaphragmatic paralysis after cervical transforaminal epidural steroid injection: illustrative case

Farrell

Mathew

Weiss

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Cervical radiculopathy is a common cause of neck pain, with radiation into the upper extremity in a dermatomal pattern. Corticosteroid injection is a conservative management option with a low risk of major adverse events. No reviewed literature or case reports have implicated phrenic nerve injury secondary to cervical transforaminal epidural steroid injection (CTFESI). OBSERVATIONS A 45-year-old man with severe right C6 radiculopathy secondary to a large right-sided C5–6 herniated intervertebral disc presented to the pain management clinic, where he received a right-sided C6 CTFESI. An hour after injection, the patient experienced shortness of breath, which was found to be caused by right diaphragmatic paralysis. The patient underwent a C5–6 anterior cervical discectomy and fusion, which provided complete relief of his radicular symptoms. However, the right hemidiaphragmatic paralysis remained at the 1-year postoperative visit. LESSONS Thorough literature review showed no established explanations for phrenic nerve injury after CTFESI. In this study, the authors explored the suspected mechanisms of possible injury to the phrenic nerve. Epidural corticosteroid injection is considered to be a safe option for conservative management of cervical radiculopathy. This study unveiled a unique and important adverse event that should be considered before a patient receives CTFESI.

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Anatomic Variation of the Phrenic Nerve and Brachial Plexus Encountered during 100 Supraclavicular Decompressions for Neurogenic Thoracic Outlet Syndrome with Associated Postoperative Neurologic Complications

Cited by 12 publications

References 6 publications

Hemidiaphragmatic paralysis following costoclavicular versus supraclavicular brachial plexus block: a randomized controlled trial

Hemidiaphragmatic paralysis following costoclavicular versus supraclavicular brachial plexus block: a randomized controlled trial

An unusual anatomical variant of the left phrenic nerve encircling the transverse cervical artery

Right hemidiaphragmatic paralysis after cervical transforaminal epidural steroid injection: illustrative case

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