Pneumothorax: a complication of nerve conduction studies using needle stimulation

Area of Science:

• Neurology
• Thoracic Surgery
• Diagnostic Procedures

Background:

• Thoracic outlet syndrome (TOS) is a complex condition involving compression of nerves and/or blood vessels in the thoracic outlet.
• Nerve conduction studies (NCS) are sometimes used in the diagnostic workup of TOS.
• Needle electrode stimulation at Erb point has been explored as a method for NCS in TOS evaluation.

Observation:

• Two patients undergoing NCS for left TOS developed left pneumothorax after needle electrode stimulation at Erb point.
• Chest X-rays confirmed 20% and 10% left pneumothorax in the affected patients.
• Needle stimulation was performed after failed percutaneous attempts.

Findings:

• The use of a 1 1/2-inch needle electrode at Erb point for NCS in TOS evaluation is associated with a risk of pneumothorax.
• This complication led to the cessation of needle electrode stimulation in the diagnostic protocol.
• The diagnosis of TOS is now determined through alternative established criteria.

Implications:

• The findings highlight a significant risk associated with invasive needle electrode use in TOS diagnostic procedures.
• Alternative, safer methods for NCS or reliance on other diagnostic criteria are now prioritized for TOS evaluation.
• This case series may influence future guidelines regarding the diagnostic approach to thoracic outlet syndrome.