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[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
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.
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.
- 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.