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Double-crush nerve compression in thoracic-outlet syndrome.
1Department of Orthopaedic Surgery, Loma Linda University Medical Center, California 92350.
The Journal of Bone and Joint Surgery. American Volume
|January 1, 1990
Summary
Thoracic-outlet syndrome can lead to further nerve compression distally, like carpal tunnel syndrome. Investigating additional nerve issues is crucial after diagnosing thoracic-outlet syndrome.
Area of Science:
- Neurology
- Orthopedic Surgery
Background:
- Thoracic-outlet syndrome (TOS) involves compression of nerves or blood vessels in the thoracic outlet.
- First rib resection is a common surgical treatment for TOS.
- The presence of distal nerve compression in TOS patients is not fully understood.
Purpose of the Study:
- To investigate the incidence and types of distal nerve compression in patients who underwent first rib resection for TOS.
- To determine if proximal nerve compression from TOS affects susceptibility to distal compression neuropathies.
Main Methods:
- Retrospective review of 165 cases of TOS in 142 patients who had first rib resection.
- Electromyography (EMG) and nerve conduction studies (NCS) were used to assess for distal nerve compression.
- Analysis of surgical history for multiple operative sites.
Main Results:
- Distal nerve compression was identified in 73 cases (44%) via EMG and NCS.
- Carpal tunnel syndrome was the most frequent secondary compression, occurring in 41 cases.
- Thirteen patients required operations at three or more sites, indicating complex compression patterns.
Conclusions:
- Proximal nerve compression associated with TOS can reduce a nerve's tolerance to distal compression.
- Following a TOS diagnosis, a thorough evaluation for coexisting distal compression neuropathies is recommended.
- Early identification of multiple compression sites can guide comprehensive treatment strategies.