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Gilliatt-Sumner hand revisited: a 25-year experience.
Gabriel C Tender1, Ajith J Thomas, Najeeb Thomas
1Department of Neurosurgery, Louisiana State University at New Orleans, New Orleans, USA.
Neurosurgery
|October 2, 2004
Summary
Surgical treatment for true neurogenic thoracic outlet syndrome (Gilliatt-Sumner hand) significantly improved pain and motor deficits. Decompression of the medial brachial plexus, particularly spinal nerves, is key for successful outcomes.
Area of Science:
- Neurology
- Neurosurgery
- Orthopedics
Background:
- True neurogenic thoracic outlet syndrome (TN-TOS), also known as Gilliatt-Sumner hand, is a rare condition.
- It results from compression of the lower brachial plexus, specifically C8, T1 nerve roots and/or lower trunk.
Purpose of the Study:
- To retrospectively evaluate surgical outcomes for pain and motor function in patients with TN-TOS.
- To determine the effectiveness of surgical decompression of the brachial plexus.
Main Methods:
- A retrospective review of 33 patients with TN-TOS who underwent surgical treatment over 25 years.
- Surgical approaches included anterior supraclavicular (19 patients) and posterior subscapular (15 patients).
- Nerve action potential recordings were used to assess plexus involvement.
Main Results:
- Pain improved in 21 out of 22 patients.
- Mild motor deficits improved in 12 out of 14 patients.
- Severe motor deficits showed partial improvement in 14 out of 20 patients.
Conclusions:
- TN-TOS diagnosis indicates a clear need for surgical intervention.
- Surgical decompression should target the medial brachial plexus, including spinal nerves.
- An anterior supraclavicular approach is generally preferred, with a posterior subscapular approach considered for specific cases like large cervical ribs or prior surgery.