Elective brachial plexus decompression in neurogenic thoracic outlet syndrome

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Vascular Surgery

Background:

• Neurogenic thoracic outlet syndrome (N-TOS) can cause significant pain, paresthesia, and motor deficits.
• Surgical decompression of the brachial plexus is a treatment option for N-TOS.

Purpose of the Study:

• To evaluate functional outcomes after elective brachial plexus decompression for N-TOS.
• To assess symptom resolution and functional recovery following surgery.

Main Methods:

• Retrospective observational study of 17 N-TOS patients (15 female, 2 male; mean age 42).
• Performed 20 brachial plexus decompressions (compressive fibrous band resection +/- bone resection).
• Evaluated outcomes via pain, paresthesia, hand motor deficit, patient-reported assessment, and Quick-DASH scores.

Main Results:

• No postoperative complications reported.
• Median follow-up of 12 months.
• Complete pain relief in 11/15 patients; paresthesia resolution in 9/14 patients.
• All patients reported symptom improvement.
• Hand muscle atrophy persisted in all evaluated cases (n=11).
• Objective N-TOS showed poorer sensorimotor recovery but better Quick-DASH scores than subjective N-TOS.

Conclusions:

• Elective brachial plexus decompression is a safe procedure for N-TOS.
• Surgery consistently improves subjective symptoms like lower trunk irritation.
• Nerve release does not reverse hand muscle atrophy in objective N-TOS patients.