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![]() Should this fail, thoracic outlet decompression can always be performed at a later date.Ĭopyright 2010 Annals of Vascular Surgery Inc. Its recognition is important as many patients with suspected NTOS can be treated successfully with a simple, essentially risk-free PM tenotomy. PMS commonly accompanies NTOS and frequently exists alone. Surgery for neurogenic TOS makes an incision above the collarbone removes the anterior scalene muscle and clears fibrous scar tissue away from each nerve to. In the combined PMS/TOS group, most of the failed patients subsequently had thoracic outlet operations. Most patients returned to work within a few days. The only complication was 3 wound infections. 1 There are two main surgical approaches to TOS decompression: transaxillary and supraclavicular. All but one of the failures was immediate, only one was late. Thoracic outlet syndrome (TOS) is an underdiagnosed and undertreated condition that occurs owing to neurogenic, arterial, and/or venous compression in the thoracic outlet. Success rates with 1-3-year follow-up for the PM-alone group were 90% good-excellent, 2% fair, and 8% failed for the combined group success rates were 35% good-excellent, 19% fair, and 46% failed. Preoperatively, 85% of the of the PM-alone group were still employed compared to only 57% of the combined group (p=0.01). Features distinguishing the PM-alone group were fewer and milder occipital headaches, less neck pain, and fewer positive physical findings. ![]() In 76 patients, 100 operations were performed: 48 for NPMS combined with NTOS and 52 for NPMS-alone. Other symptoms were extremity pain, weakness, and paresthesia, similar to symptoms of NTOS. It can become damaged or narrowed because of an accident, pregnancy or a congenital (present at. The thoracic outlet is the name of space between the collarbone and first rib. The clinical picture included pain or tenderness in the anterior chest wall and axilla, together with physical findings of tenderness over the pectoralis minor tendon. Thoracic outlet syndrome is a set of symptoms affecting the shoulder, arm or hand due to pressure on the nerves and blood vessels in the upper part of the chest. Artery-related (arterial) involves compression of the subclavian artery as it exits the chest and travels to. Nerve-related (neurogenic) involves compression of one or more brachial plexus nerves from the neck to the hands Arterial thoracic outlet syndrome. ![]() Pectoralis minor tenotomy was performed as an outpatient procedure under local anesthesia with heavy sedation through a 5-7 cm transaxillary incision. There are three types of thoracic outlet syndrome: Neurogenic thoracic outlet syndrome. Since 2005 when we became aware of pectoralis minor syndrome (PMS), more than 75% of patients diagnosed with neurogenic thoracic outlet syndrome (NTOS) also have neurogenic PMS (NPMS), and about 30% have only NPMS, without NTOS.ĭiagnosis was made based on history, physical examination, pectoralis minor (PM), and scalene muscle blocks with lidocaine.
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