Abstract
Background: Thoracic outlet syndrome compression of the brachial plexus in the area between the clavicle and the first rib is a commonly spread and important pathology. It occurs, as usual, after a trauma or due to an anatomical malformation of this area. Thoracic outlet syndrome can be combined with a shoulder joint pathology. In the case of a conservative treatment's failure, the standard surgical procedure is decompression of the brachial plexus in the thoracic aperture. This procedure is usually done via an open approach. The development of the endoscopic surgical technique of decompression allows reducing the risk of complications and recurrences, improving the cosmetic result and relieving the rehabilitation period. Clinical case description: A 73-year-old female patient with a clinical picture of posttraumatic brachial plexopathy and a massive shoulder rotator cuff tear. The patient underwent a conservative treatment for 6 months after the trauma without a significant improvement. To confirm the diagnosis, ENMG and an ultrasound investigation of the brachial plexus, as well as MRI of the shoulder joint were performed. Simultaneous shoulder joint arthroscopy with subacromial spacer implantation and brachial plexus decompression in the thoracic aperture were performed to the patient. According to the VAS-scale (Visual Analogue Scale), the severity of pain syndrome before the surgery was 10 cm, while 6 months after the surgery, it decreased to 1 cm. According to the DASH scale (Disabilities of the Arm, Shoulder, and Hand), the dysfunction of the of shoulder joint before the surgery was 76 points, while 6 months after the surgery, it decreased to 12 points. The range of motion in the shoulder joint before the surgery was as follows: flexion 105, abduction 95, external rotation 15, which increased to 160, 165, and 45, respectively, 6 months after the surgery. Conclusion: The results allow us to characterize the method of simultaneous shoulder joint arthroscopy and endoscopic decompression of the brachial plexus in the thoracic aperture as a low-traumatic and effective technique. The technique provides complete brachial plexus decompression in the thoracic aperture which promotes restoration of the function of the upper extremity and shoulder joint, and elimination of pain syndrome from the upper extremity area.
Reference24 articles.
1. Thoracic Outlet Syndrome
2. Куцай Н.В., Головина Е.Р., Аджисалиев Г Р. Современные методы лечения синдрома верхней апертуры грудной клетки // Инновации. Наука. Образование. 2020. № 24. С. 1933–1939. [Kutsyy NV, Golovina ER, Adjisaliev GR. Modern methods of treatment of upper chest aperture syndrome. Innovations. The science. Education. 2020;(24):1933–1939. (In Russ).]
3. Síndrome do desfiladeiro torácico: uma revisão narrativa.
4. Магомедов Р.К., Цуладзе И.И., Древаль О.Н., Чапандзе Г.Н. Клинико-диагностические особенности нейроваскулярного компрессионного синдрома в области верхней грудной апертуры // Российский нейрохирургический журнал им. проф. А.Л. Поленова. 2021. Т. 13, № S1. С. 106. [Magomedov RK, Tsuladze II, Dreval ON, Kapanadze GN. Clinical and diagnostic features of neurovascular compression syndrome in the upper thoracic aperture. Russ Neurosur J named after Professor A.L. Polenov. 2021;13(S1):106. (In Russ).]
5. Thoracic Outlet Syndrome: Definition, Aetiological Factors, Diagnosis, Management and Occupational Impact