Neurogenic thoracic outlet decompression: rationale for sparing the first rib

Cheng, Stephen W.K.; Reilly, Linda M.; Nelken, N. A.; Ellis, Wladislaw; Stoney, Ronald J.

doi:10.1016/0967-2109(96)82859-6

Cited by 61 publications

(23 citation statements)

References 12 publications

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“…Prior studies have suggested that longer duration of symptoms was associated with a poorer outcome. 3,7,8 It could be postulated that, similar to various other complex regional pain syndromes, persistent repetitive stimulation of central pain pathways over time results in autonomous signal generators that could confound results. 4,9 However, to the best of our knowledge, our study is the first to show that this association was more closely associated with age.…”

Section: Discussionmentioning

confidence: 98%

Impact of anterior scalene lidocaine blocks on predicting surgical success in older patients with neurogenic thoracic outlet syndrome

Lum

Brooke

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et al. 2012

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 98%

Impact of anterior scalene lidocaine blocks on predicting surgical success in older patients with neurogenic thoracic outlet syndrome

Lum

Brooke

Likes

et al. 2012

Journal of Vascular Surgery

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“…Reports of substantial morbidity have been advanced as reasons to be cautious when advocating TOS surgery. 7,8,10,37 The results of this study implicate the first rib as the major factor in causing TOS. The implication is that the rib occupies a high position such that it pushes up on the lower aspect of the plexus.…”

Section: Transaxillary Resection the Optimal Operationmentioning

confidence: 74%

“…Substantial complication rates have been reported for TOS. 7,8,10,37 In this series no patient suffered any morbidity, but the senior author (J.N.C.) has observed transient brachial plexus deficits in other surgically treated patients.…”

Section: Transaxillary Resection the Optimal Operationmentioning

confidence: 90%

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Surgical treatment of thoracic outlet syndrome: a randomized trial comparing two operations

Sheth¹,

Campbell²

2005

Journal of Neurosurgery: Spine

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Object. Various surgical approaches have been proposed for the treatment of thoracic outlet syndrome (TOS). The authors of this study focused on the differences in outcome after supraclavicular neuroplasty of brachial plexus (SNBP [no rib resection]) and transaxillary first rib resection (TFRR) in patients in whom the dominant clinical problem was pain. Methods. Fifty-five patients were randomized to undergo TFRR or SNBP. Patients with an anomalous cervical rib, intrinsic weakness, and primarily vascular findings were excluded from the study. Preoperatively, the following findings were typically observed: provocation of symptoms by certain postures (the so-called spear-throwing position as well as downward tugging of the shoulder) and marked tenderness in the supraclavicular fossa. The intergroup severity of the symptoms was comparable. Eight patients were lost to follow up. There were 24 TFRRs (in two cases the procedure was bilateral) and 25 SNBPs. The mean follow-up interval was 37 months. In both groups pain decreased significantly after surgery. By all measures the TFRR operation conferred superior results. Patients reported significantly less pain (39 ± 7 compared with 61 ± 7; score range 0–100 on a visual analog scale), greater percentage of pain relief (52 ± 8% compared with 30 ± 7%), and less pain (3.7 ± 0.4 compared with 5.1 ± 0.5) on an affective scale (all p < 0.05) in the TFRR and SNBP groups, respectively). In the TFRR group, 75% of patients reported good or excellent outcomes compared with 48% in the SNBP group (p < 0.05). Conclusions. Transaxillary first rib resection provided better relief of symptoms than SNBP. The major compressive element in patients with TOS-associated pain appeared to be the first rib.

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“…In one study, patients with NTOS underwent an anterior and middle scalenectomy with or without a first rib resection. [47] The authors used a supraclavicular approach for the scalenectomy and the first rib resection. Patients with cervical ribs were managed differently, as the first rib was removed, and they were not used in the study.…”

Section: Literature Reviewmentioning

confidence: 99%

Neurogenic thoracic outlet syndrome: A case report and review of the literature

Boezaart¹,

Haller²,

Laduzenski³

et al. 2010

Int J Shoulder Surg

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Neurogenic thoracic outlet syndrome (NTOS) is an oft-overlooked and obscure cause of shoulder pain, which regularly presents to the office of shoulder surgeons and pain specialist. With this paper we present an otherwise healthy young female patient with typical NTOS. She first received repeated conservative treatments with 60 units of botulinium toxin injected into the anterior scalene muscle at three-month intervals, which providing excellent results of symptom-free periods. Later a trans-axillary first rib resection provided semi-permanent relief. The patient was followed for 10 years after which time the symptoms reappeared. We review the literature and elaborate on the anatomy, sonoanatomy, etiology and characteristics, symptoms, diagnostic criteria and treatment modalities of NTOS. Patients with NTOS often get operated upon – even if just a diagnostic arthroscopy, and an interscalene or other brachial plexus block may be performed. This might put the patient in jeopardy of permanent nerve injury, and the purpose of this review is to minimize or prevent this.

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Neurogenic thoracic outlet decompression: rationale for sparing the first rib

Cited by 61 publications

References 12 publications

Impact of anterior scalene lidocaine blocks on predicting surgical success in older patients with neurogenic thoracic outlet syndrome

Impact of anterior scalene lidocaine blocks on predicting surgical success in older patients with neurogenic thoracic outlet syndrome

Surgical treatment of thoracic outlet syndrome: a randomized trial comparing two operations

Neurogenic thoracic outlet syndrome: A case report and review of the literature

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