An isolated double-crush-syndrome in posttraumatic thoracic outlet syndrome - A case report

Thoracic outlet Syndrome (TOS) includes all disorders caused by compression of all neurovascular Structures in the upper thoracic outlet (Ross and Owners, 1966, Bürger and Arterien, 2014, Sanders and Annest, 2017). The Double-Crush-Syndrome (DBS) defines multilevel lesions along a neurovascular trunk caused by mechanical compression in different areas. Pectoralis-minor-syndrome (PMS) is also classified in the disorders of he upper thoracic outlet and was also known as hyperabductionsyndrome or subcoracoidal-syndrome. Between 2015-2019 our department treatet 488 patients suffering from neurological, vascular or combined TOS. Surgical treatment, depending on clinical and specific diagnostics was performed in 175 cases via transaxillary approach, including cervical rib resection, first rib resection, neurolysis of plexus brachialis, thoracal sympathectomy or vascular reconstruction. In all this year just a single patient with double crush syndrome was present. CASE PRESENTATION AND METHODS: We report a case of a 28-years old female patient, reported in line with the SCARE criteria [13], suffering from neurvascular compression in the upper thoracic outlet after surgically treated clavicula fracture. She developed typical symptomes of a Thoracic Outlet Syndrome. CONCLUSION: Double-Crush-Syndrome in patients with Thoracic Outlet Syndrome are very rare, case reports seldomly exist. The diagnosis requires a specific clinical testing and x-ray radiography. Furthermore dynamic tests like ultrasound and angiography and neurophysiological testing requires a high degree of experience, so the compressed area can be detected. Treatment includes an attempt of best medical and physical therapy, in case of failure a surgical treatment is necessary.