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Thoracic outlet syndrome surgery causing severe brachial plexopathy.

A J Wilbourn1

  • 1Department of Neurology, Cleveland Clinic Foundation, OH 44106.

Muscle & Nerve
|January 1, 1988
PubMed
Summary

First rib resections for neurogenic thoracic outlet syndrome (NTOS) can cause brachial plexus injuries. This review details these neurological complications, their history, and causes, highlighting underreported risks associated with TOS surgery.

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Vascular Surgery

Background:

  • First rib resection is a common procedure for neurogenic thoracic outlet syndrome (NTOS).
  • Historically, serious neurological complications were considered rare following this surgery.
  • A significant number of brachial plexus injuries were identified as potentially linked to this procedure.

Purpose of the Study:

  • To discuss the features of "true" and "disputed" NTOS.
  • To trace the history of brachial plexus injuries during thoracic outlet syndrome (TOS) surgery.
  • To analyze the clinical and electrophysiological characteristics of patients with these injuries.

Main Methods:

  • Review of historical surgical records and literature.
  • Detailed case study of eight patients with brachial plexus injuries post-TOS surgery.

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  • Analysis of injury locations and causative factors.

    • Main Results:

    • Identified nearly 300 brachial plexus injuries associated with first rib resections.
    • Described clinical and electrophysiological findings in affected patients.
    • Discussed the historical underreporting of these neurological deficits.

    Conclusions:

    • Brachial plexus injuries are a notable risk of first rib resection for NTOS.
    • Understanding the history and causes is crucial for prevention.
    • Further investigation into surgical techniques and patient selection is warranted.