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Rare Case of Dynamic Thoracic Outlet Syndrome Resolved by an Isolated Subclavius Posticus Muscle Resection: A Case
Ruben Dukan1, Gautier Petroni1, Guy-Paul Muller2
1Hand, Upper Limb, and Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), Paris, France.
JBJS Case Connector
|November 12, 2021
Summary
Dynamic neurogenic thoracic outlet syndrome (TOS) caused by the subclavius posticus muscle (SPM) can be treated with surgery. Surgical release of the SPM led to immediate symptom resolution in this case.
Area of Science:
- Neurology
- Orthopedic Surgery
- Radiology
Background:
- Thoracic outlet syndrome (TOS) is a condition that can cause neurogenic symptoms.
- The subclavius posticus muscle (SPM) is an underrecognized cause of TOS.
Observation:
- A patient presented with dynamic neurogenic TOS and a persistent fifth finger abduction (Wartenberg sign).
- Magnetic resonance imaging (MRI) identified the presence of the SPM.
Findings:
- Nonoperative management failed to resolve the patient's symptoms.
- Surgical intervention, including brachial plexus neurolysis and SPM resection, was performed.
- The Wartenberg sign resolved immediately following the surgery.
Implications:
- SPM should be considered in the differential diagnosis of neurogenic TOS.
- Careful MRI interpretation is crucial for diagnosing SPM-related TOS.
- Surgical decompression offers a viable treatment option for refractory cases of TOS caused by SPM.
