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Upper plexus thoracic outlet syndrome--case report.

Takeshi Matsuyama1, Kazuo Okuchi, Kazuo Goda

  • 1Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara. tmatsuya@nmu-gw.naramed-u.ac.jp

Neurologia Medico-Chirurgica
|June 18, 2002
PubMed
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This case study highlights a rare instance of upper plexus thoracic outlet syndrome (TOS) caused by fibromuscular bands. Surgical decompression via supraclavicular scalenectomy successfully resolved the patient's debilitating shoulder and arm symptoms.

Area of Science:

  • Neurology
  • Surgical Anatomy

Background:

  • Thoracic outlet syndrome (TOS) can present with varied symptoms, often involving lower cervical nerves.
  • Upper plexus TOS, affecting C5-C7 nerve roots, is a less common but significant manifestation.

Observation:

  • A 47-year-old female presented with proximal right shoulder and elbow ache, muscle weakness, and atrophy.
  • Physical examination revealed positive Morley and elevated arm stress tests, indicative of neurovascular compression.
  • Intraoperative findings included an abnormal fibromuscular band constricting the middle trunk of the brachial plexus and a scalene muscle anomaly.

Findings:

  • Surgical intervention involved neurolysis of the brachial plexus and anterior scalenectomy via a supraclavicular approach.
  • Resection of anomalous fibromuscular and scalene muscles was performed, followed by extensive neurolysis.

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  • The patient experienced complete resolution of symptoms and was discharged five days post-surgery.

    • Implications:

    • Supraclavicular scalenectomy is an effective surgical option for managing upper plexus TOS.
    • Identifying and resecting anomalous fibromuscular bands and muscles is crucial for successful treatment.
    • This case underscores the importance of considering anatomical variations in TOS diagnosis and management.