1/35. AAEM case report 33: costoclavicular mass syndrome. American association of Electrodiagnostic medicine.A true costoclavicular mass syndrome associated with a brachial plexopathy is rare. We report the occurrence of a severe brachial plexopathy as a late complication of a displaced midclavicular fracture. An exuberant callus associated with the clavicular fracture acted as a mass lesion to compress the brachial plexus within the costoclavicular space (i.e., between the clavicle and the first rib). The clinical features and the electrodiagnostic findings in this patient were crucial in suggesting the diagnosis, which was subsequently confirmed by radiographic studies and surgical exploration. Surgical excision of the hyperabundant callus and freeing of the entrapped brachial plexus resulted in marked improvement of the patient's neurological symptoms. Recognition of this uncommon complication of a clavicular fracture is important for the timely diagnosis of this treatable problem.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
2/35. thoracic outlet syndrome in aquatic athletes.thoracic outlet syndrome is a well-recognized group of symptoms resulting from compression of the subclavian artery and vein, as well as the brachial plexus, within the thoracic outlet. Symptoms are related directly to the structure that is compressed. diagnosis is difficult because there is no single objective, reliable test; therefore, diagnoses of thoracic outlet syndrome is based primarily on a set of historical and physical findings, supported and corroborated by a host of standard tests. Because aquatic athletes are primarily "overhead" athletes, one may expect a higher incidence of thoracic outlet syndrome in this population. The differential between TOS and "swimmer's shoulder" (multidirectional instability and subacromial impingement) may be difficult. Nonsurgical treatment methods can be helpful in relieving symptoms; in certain recalcitrant cases, however, surgical intervention can provide lasting relief and a return to aquatic athletics.- - - - - - - - - - ranking = 0.5keywords = plexus (Clic here for more details about this article) |
3/35. Migraine complicated by brachial plexopathy as displayed by MRI and MRA: aberrant subclavian artery and cervical ribs.This article describes migraine without aura since childhood in a patient with bilateral cervical ribs. In addition to usual migraine triggers, symptoms were triggered by neck extension and by arm abduction and external rotation; paresthesias and pain preceded migraine triggered by arm and neck movement. Suspected thoracic outlet syndrome was confirmed by high-resolution bilateral magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brachial plexus. An unsuspected aberrant right subclavian artery was compressed within the scalene triangle. The aberrant subclavian artery splayed apart the recurrent laryngeal and vagus nerves, displaced the esophagus anteriorly, and effaced the right stellate ganglia and the C8-T1 nerve roots. Scarring and fibrosis of the left scalene triangle resulted in acute angulation of the neurovascular bundle and diminished blood flow in the subclavian artery and vein. A branch of the left sympathetic ganglia was displaced as it joined the C8-T1 nerve roots. Left scalenectomy and rib resection confirmed the MRI and MRA findings; the scalene triangle contents were decompressed, and migraine symptoms subsequently resolved.- - - - - - - - - - ranking = 0.5keywords = plexus (Clic here for more details about this article) |
4/35. Cervical root stimulation in a case of classic neurogenic thoracic outlet syndrome.We performed C8 nerve root stimulation in addition to other electromyographic (EMG) studies in a surgically proven case of classic thoracic outlet syndrome (TOS). The patient was a 19-year-old woman with a 2-year history of right hand cramps and progressive weakness and atrophy of hand muscles, especially the thenar eminence. Routine EMG studies showed evidence for an axon-loss lower trunk brachial plexopathy. Stimulation studies of the C8 nerve roots demonstrated proximal conduction block on the affected side only. The diagnosis was further supported by cervical spine radiographs, which demonstrated a cervical rib, and surgical exploration of the brachial plexus, which demonstrated upward compression and stretching of the lower trunk by a fascial band extending from the anomalous cervical rib to the first thoracic rib. The patient noted a modest improvement in hand function postoperatively. Root stimulation studies can help in the diagnosis of classic TOS by providing more precise localization and information regarding the degree, if any, of proximal motor conduction block.- - - - - - - - - - ranking = 0.5keywords = plexus (Clic here for more details about this article) |
5/35. Subclavius posticus muscle: supernumerary muscle as a potential cause for thoracic outlet syndrome.During routine dissection a subclavius posticus muscle was found on the left side of a male cadaver. This muscle arose from the upper margin of the scapula and transverse scapular ligament, inserted in the superior side of the first rib cartilage, and was innervated by a small branch from the suprascapular nerve. The anatomical relationships of the supernumerary muscle with the brachial plexus and the subclavian artery is suggestive of a possible cause of the thoracic outlet syndrome and therefore of clinical significance.- - - - - - - - - - ranking = 0.5keywords = plexus (Clic here for more details about this article) |
6/35. thoracic outlet syndrome caused by first rib hemangioma.We report a case of first rib hemangioma that caused thoracic outlet syndrome. A 50-year-ole woman who was admitted to our hospital with a clinical diagnosis of thoracic outlet syndrome presented with fullness and easy fatigue of her right arm. Her right arm discomfort was associated with intermittent engorgement of superficial veins over the shoulder girdle. A chest radiograph revealed an enlargement of the anterior aspect of the first rib with fine bony trabeculations. Computed tomography scan showed contrast enhancement over the enlarged rib. Our tentative preoperative diagnosis was a benign first rib hypertrophic change, such as an old fracture with exuberant callus formation. A right-arm venogram revealed a patent subclavian vein with an extrinsic compression, which occluded on arm abduction. The findings of neural conduction studies of both upper extremities were symmetric and normal. The patient agreed to surgery because of the occlusive condition of the subclavian vein on arm abduction and progressive arm weakness in recent months. Segmental transection of the offending portion of the enlarged first rib was complicated by difficulty in isolating the whole length of the compressed but normal-appearing subclavian vein by our initial transaxillary and infraclavicular approaches because the medial aspect of the subclavian vein was obstructed by the enlarged first rib, which extended medially to the junction of the right jugular and subclavian veins. Successful segmental transection of the enlarged first rib was finally accomplished by combined transaxillary, infraclavicular, and supraclavicular approaches. A moderate amount of rib bleeding from resection ends was noted during segmental resection of the enlarged first rib, resulting in local hematoma formation. A 470-mL bloody discharge was collected from the vacuum ball inserted via the transaxillary route during her 12-day hospitalization. Pathologic examination revealed an intraosseous hemangioma. The patient had a prolonged course to partial recovery of her arm numbness, but signs of venous compression were much improved at 6 months' follow-up. Although hemangioma is benign, its hypervascular nature may cause catastrophic intraoperative bleeding.- - - - - - - - - - ranking = 0.00036199108080406keywords = chest (Clic here for more details about this article) |
7/35. Posterior subscapular approach for specific brachial plexus lesions.The surgical technique for exposure of the brachial plexus via a posterior subscapular approach is reviewed, with its relevant anatomy. The author has used this approach for four brachial plexus procedures. The indications for this approach will be discussed, and a case history presented to illustrate the benefits of this procedure in recurrent thoracic outlet syndrome.- - - - - - - - - - ranking = 3keywords = plexus (Clic here for more details about this article) |
8/35. thoracic outlet syndrome with subclavian aneurysm in a very young child: the complementary value of MRA and 3D-CT in diagnosis.thoracic outlet syndrome (TOS) is rare in childhood. In adults, TOS results in compression of the neurovascular bundle (branches of the brachial plexus and the subclavian artery), but more than 95% of cases present solely with neurologic compression. We present a case of TOS in a very young child and describe the rare finding of subclavian artery compression and post-stenotic aneurysm. The clinical features, imaging workup, and surgical findings are discussed. The combination of three-dimensional MR angiography and CT was of great value in diagnosis and surgical planning.- - - - - - - - - - ranking = 0.5keywords = plexus (Clic here for more details about this article) |
9/35. Normative values for high voltage electrical stimulation across the brachial plexus.OBJECTIVES: To obtain normative values for High Voltage Electrical Stimulation across the brachial plexus between Erb's point, C8 root and T1 root. A case study of probable true thoracic outlet syndrome is used to illustrate the usefulness of the method. methods: 22 patients were tested for use in normative date pool with complaints unrelated to the ulnar nerve, the majority of which were pure carpal tunnel syndrome. High voltage stimulation was performed at Erb's point, C8 root and T1 root. Recording was from the abductor digit minimi muscle. RESULTS: Upper limit for absolute latencies were 13.9 ms, 14.5 ms and 14.5 ms for Erb's point, C8 root and T1 root stimulation respectively. Corresponding lower limits of amplitude were 4.8 mV, 3.4 mV and 2.9 mV. Upper limits for interpeak latencies were 1.4 ms and 1.2 ms for C8 to Erb's point and T1 to Erb's point respectively. In a case of true thoracic outlet syndrome, the symptomatic side revealed prolonged interpeak and absolute latencies. The asymptomatic side remained within normal limits. CONCLUSION: Normative values for high voltage stimulation across the brachial plexus are useful in cases of suspected compression in this proximal location of the upper limb.- - - - - - - - - - ranking = 3keywords = plexus (Clic here for more details about this article) |
10/35. Upper plexus thoracic outlet syndrome--case report.A 47-year-old right-handed female became aware of proximal ache and muscle weakness in the right shoulder and elbow in 1997. atrophy of the right biceps muscle was recognized and the right deltoid, triceps, supraspinatus, and infraspinatus muscles were weak. The Morley test and elevated arm stress test were positive. Neurolysis of the brachial plexus and anterior scalenectomy were performed via a right supraclavicular approach. An abnormal fibromuscular band was identified passing between the upper and middle trunks and constricting the middle trunk. Another scalene muscle anomaly was found passing between the C-5 and C-6 nerve roots and connecting the anterior and middle scalene muscles. These muscles were resected, and thorough neurolysis was performed around all nerves and the trunks. Postoperatively, all symptoms completely resolved and the patient was discharged 5 days after surgery. thoracic outlet syndrome (TOS) manifests as symptoms of lower cervical nerve involvements with hypesthesia and paresthesia. However, upper plexus TOS manifests as symptoms due to the involvement of the C-5 to C-7 nerve roots, and is relatively rare. Transaxillary first rib resection is performed as the primary operation for TOS, but supraclavicular scalenectomy is effective for upper plexus TOS.- - - - - - - - - - ranking = 3.5keywords = plexus (Clic here for more details about this article) |
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