Frequency of the Pectoralis Minor Compression Syndrome in Patients Treated for Thoracic Outlet Syndrome

Ammi, Myriam; Peret, M.; Henni, Samir; Daligault, Mickaël; Ábrahám, Pierre; Papon, X.; Enon, B; Picquet, Jean

doi:10.1016/j.avsg.2017.09.002

Cited by 20 publications

(16 citation statements)

References 33 publications

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“…As described by Demondion et al (2006), the diagnosis is based on clinical findings, but making this diagnosis is often difficult. The use of imaging (radiography, ultrasonography, computed tomographic angiography, or magnetic resonance imagery) is required to determine the nature and location of the underlying structures causing the compression (Ammi et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Microvascular Response to the Roos Test Has Excellent Feasibility and Good Reliability in Patients With Suspected Thoracic Outlet Syndrome

et al. 2019

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Background: Exercise oximetry allows operator-independent recordings of microvascular blood flow impairments during exercise and can be used during upper arm provocative maneuvers. Objective: To study the test-retest reliability of upper-limb oximetry during the Roos test in patients with suspected thoracic outlet syndrome (TOS). Materials and Methods: Forty-two patients (28 men, 14 women; mean age: 40.8 years) were examined via transcutaneous oxygen pressure (TcpO2) recordings during two consecutive Roos tests in the standing position. The minimal decrease from rest of oxygen pressure (DROPmin) value was recorded after each maneuver was performed on both arms. The area under the receiver operating characteristic (ROC) curve defined the DROPmin diagnostic performance in the presence of symptoms during the tests. The Mann–Whitney U -test was used to compare the DROPmin in the symptomatic vs. asymptomatic arms. The test-retest reliability was analyzed with Bland-Altman representations. The results are presented as means ± standard deviations (SD) or medians [25–75 percentiles]. Results: The symptoms by history were different from the symptoms expressed during the Roos maneuvers in one-third of the patients. The DROPmin measurements were −19 [−36; −7] mmHg and −8 [−16; −5] mmHg in the symptomatic ( n = 108) and asymptomatic ( n = 60) arms, respectively. When TOS observed on ultrasound imaging was the endpoint, the area under the ROC curve (AUC) was 0.725 ± 0.058, with an optimal cutoff point of −15 mmHg. This value provided 67% sensitivity and 78% specificity for the presence TOS via ultrasound. When symptoms occurring during the test represented the endpoint, the AUC was 0.698 ± 0.04, with a cutoff point of −10 mmHg. This provided 62% sensitivity and 66% specificity for the presence of pain in the ipsilateral arm during the test. The test-retest reliability of DROPmin proved to be good but not perfect, partly because of unreliability of the provocation maneuvers. Conclusion: To the best of our knowledge, this study is the first to investigate microvascular responses during the Roos maneuver in patients with suspected TOS. The presence of symptoms was significantly associated with ischemia. TcpO2 facilitated the recording of both macrovascular and microvascular responses to the Roos test. The Roos maneuver should probably be performed at least twice in patients with suspected TOS.

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Section: Introductionmentioning

confidence: 99%

Microvascular Response to the Roos Test Has Excellent Feasibility and Good Reliability in Patients With Suspected Thoracic Outlet Syndrome

et al. 2019

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“…(c) pectoralis minor space (space with three trunks, cords of the brachial plexus and a vascular bundle; Sul et al, 2019). Pectoralis minor compression syndrome is a constriction of the elements of the subpectoral tunnel (Ammi et al, 2018). The main clinical signs of these two pathologies are almost identical and include pain in the shoulder, paraesthesia, numbness of the upper extremity, and weakness of the F I G U R E 3 Scheme of the brachial plexus and the terminal branches of the lateral pectoral nerve.…”

Section: Discussionmentioning

confidence: 99%

“…The thoracic outlet is divided into three areas: (a) scalene triangle (C5–C8 and T1 roots, subclavian artery); (b) costoclavicular space (the space between the clavicle, the first rib with trunks of the brachial plexus and the subclavian artery and vein); (c) pectoralis minor space (space with three trunks, cords of the brachial plexus and a vascular bundle; Sul et al, ). Pectoralis minor compression syndrome is a constriction of the elements of the sub‐pectoral tunnel (Ammi et al, ). The main clinical signs of these two pathologies are almost identical and include pain in the shoulder, paraesthesia, numbness of the upper extremity, and weakness of the upper limb.…”

Section: Discussionmentioning

confidence: 99%

Innervation of the clavicular part of the deltoid muscle by the lateral pectoral nerve

et al. 2020

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Introduction: The innervation pattern of the clavicular head of the deltoid muscle and its corresponding topography was investigated via cadaveric dissection in the present study, focusing on the lateral pectoral nerve. Materials and methods: Fifty-eight upper extremities were dissected and the nerve supplies to the deltoid muscle and the variability of the lateral pectoral and axillary nerves, including their topographical patterns, were noted. Results: The clavicular portion of the deltoid muscle received a deltoid branch from the lateral pectoral nerve in 86.2% of cases. Two topographical patterns of the lateral pectoral nerve were observed, depending on the branching level from the brachial plexus: a proximal variant, where the nerve entered the pectoral region under the clavicle, and a distal variant, where the nerve entered the pectoral region from

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“…In pectoralis minor syndrome, there is compression of the brachial plexus under the pectoralis minor muscle in the subpectoral tunnel [68]. It may account for a significant number of cases of thoracic outlet syndrome with one study reporting a prevalence of 22.6% among patients referred for treatment of thoracic outlet syndrome and was found to be the only cause of nerve compression in 6.1% of cases [69]. Although we are aware of no studies linking pectoralis minor syndrome and breast cancer, the authors attest to seeing it in clinical practice.…”

Section: Pectoralis Minor Syndrome/neurogenic Thoracic Outlet Syndromementioning

confidence: 99%

A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment

Chang

Asher

Smith

2021

Cancers

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Persistent pain following treatment for breast cancer is common and often imprecisely labeled as post-mastectomy pain syndrome (PMPS). PMPS is a disorder with multiple potential underlying causes including intercostobrachial nerve injury, intercostal neuromas, phantom breast pain, and pectoralis minor syndrome. Adding further complexity to the issue are various musculoskeletal pain syndromes including cervical radiculopathy, shoulder impingement syndrome, frozen shoulder, and myofascial pain that may occur concurrently and at times overlap with PMPS. These overlapping pain syndromes may be difficult to separate from one another, but precise diagnosis is essential, as treatment for each pain generator may be distinct. The purpose of this review is to clearly outline different pain sources based on anatomic location that commonly occur following treatment for breast cancer, and to provide tailored and evidence-based recommendations for the evaluation and treatment of each disorder.

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Frequency of the Pectoralis Minor Compression Syndrome in Patients Treated for Thoracic Outlet Syndrome

Cited by 20 publications

References 33 publications

Microvascular Response to the Roos Test Has Excellent Feasibility and Good Reliability in Patients With Suspected Thoracic Outlet Syndrome

Microvascular Response to the Roos Test Has Excellent Feasibility and Good Reliability in Patients With Suspected Thoracic Outlet Syndrome

Innervation of the clavicular part of the deltoid muscle by the lateral pectoral nerve

A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment

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