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Related Experiment Videos

[True neurological thoracic outlet syndrome].

N Le Forestier1, P Mouton, T Maisonobe

  • 1Fédération d'explorations fonctionnelles neurologiques, Hôpital de la Salpêtrière, Paris.

Revue Neurologique
|February 29, 2000
PubMed
Summary

True thoracic outlet syndrome (TOS) is a rare neurological condition caused by brachial plexus compression. This study highlights its diagnosis and surgical treatment in 10 female patients, noting pain relief post-surgery.

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Area of Science:

  • Neurology
  • Orthopedic Surgery

Background:

  • Thoracic outlet syndrome (TOS) is a complex group of disorders affecting the neurovascular bundle at the thoracic outlet.
  • Neurogenic TOS (true TOS), caused by lower brachial plexus compression, is rare and often misdiagnosed.
  • This study focuses on a specific, clearly defined neurological form of TOS.

Purpose of the Study:

  • To describe the clinical presentation, electrophysiological findings, and surgical outcomes of patients with true TOS.
  • To evaluate the diagnostic utility of medial antebrachial cutaneous sensory nerve action potential in true TOS.
  • To emphasize the importance of identifying and surgically treating this specific neurological syndrome.

Main Methods:

  • Retrospective analysis of 10 patients diagnosed with true TOS.

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  • Clinical examination focusing on pain, sensory deficits, and thenar muscle atrophy.
  • Electrophysiological studies including compound muscle and sensory nerve action potentials (ulnar, median, and medial antebrachial cutaneous nerves).
  • Radiographic assessment for cervical ribs or elongated C7 transverse processes.
  • Surgical decompression by removing fibrous bands compressing the lower brachial plexus.

    • Main Results:

    • All 10 patients were female, presenting with insidious onset of pain and severe unilateral thenar atrophy.
    • Electrophysiology indicated chronic axon loss in the lower brachial plexus (C8-T1).
    • Medial antebrachial cutaneous sensory nerve action potential was absent or reduced in 90% of patients, confirming C8-T1 radiculopathy.
    • Radiography revealed cervical ribs or elongated C7 transverse processes in all cases.
    • Surgery relieved pain within 1-4 weeks, with minimal motor improvement after one year.

    Conclusions:

    • True TOS is a distinct neurological syndrome characterized by lower brachial plexus compression.
    • Medial antebrachial cutaneous sensory nerve action potential is a valuable diagnostic tool for true TOS.
    • Surgical decompression effectively alleviates pain, though motor recovery may be limited.