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Brachial plexus injuries with causalgia resulting from transaxillary rib resection
Archives of Surgery (Chicago, Ill. : 1960)
|October 1, 1985
Summary
Transaxillary rib resection for thoracic outlet syndrome can cause severe brachial plexus injury and causalgia. This surgical approach carries significant risks, including permanent nerve damage and psychological distress.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Pain Management
Background:
- Thoracic outlet syndrome (TOS) is a condition caused by compression of nerves or blood vessels in the thoracic outlet.
- The transaxillary approach is a surgical method used for rib resection in TOS treatment.
- Patient outcomes following this procedure require careful evaluation.
Observation:
- Four patients undergoing transaxillary first rib resection for suspected TOS experienced severe complications.
- All patients developed permanent brachial plexus damage.
- Reported sequelae included causalgia, hand muscle weakness, sensory deficits, and autonomic dysfunction.
Findings:
- The transaxillary approach led to significant and irreversible brachial plexus injury in all observed cases.
- Causalgia, a severe neuropathic pain, was the most prominent complication.
- Narcotic analgesic abuse and severe psychological depression, including one suicide, were noted in the patient cohort.
Implications:
- The findings suggest that enthusiasm for transaxillary rib resections in TOS should be moderated.
- There is a critical need to consider the potential for severe, permanent neurological damage and intractable pain.
- Alternative or modified surgical techniques may be necessary to mitigate these risks in TOS management.