Iatrogenic compression of the thoracic outlet

Area of Science:

• Orthopedic Surgery
• Neuroscience
• Anatomy

Background:

• Surgical interventions in the thoracic outlet region carry risks of neurovascular complications.
• Iatrogenic injuries, including arterial damage and brachial plexus compression, have been documented.
• These injuries can arise from procedures altering the costo-clavicular space.

Observation:

• An initial report detailed iatrogenic injury during scapular lowering for Sprengel's deformity correction in a child.
• Neurovascular bundle compression occurred between the clavicle and first rib during this surgical migration.
• Two adult cases of iatrogenic brachial plexus injury are presented following clavicle area operations.

Findings:

• The developmental anatomy of the costo-clavicular area and upper limb descent is reviewed.
• Alterations in the clavicle-first rib relationship can occur in adults due to surgery.
• Correction of iatrogenic brachial plexus injuries was achieved by restoring the costo-clavicular space.

Implications:

• Understanding thoracic outlet anatomy is crucial for preventing surgical complications.
• Awareness of potential neurovascular compression is vital for surgeons operating in the clavicle and shoulder region.
• Restoring anatomical relationships, specifically the costo-clavicular space, can effectively manage iatrogenic brachial plexus injuries.