Post-Traumatic Thoracic Outlet Syndromes
Section snippets
INTRODUCTION
Thoracic outlet syndrome (TOS) has been reported since antiquity. Operative treatment with rib resection was described first through a supraclavicular approach in 1905 and then through a transaxillary approach in 1966.1, 2 The frequency of TOS is low. Symptoms result from compression of the brachial plexus and subclavian vascular structures. Neurological symptoms with pain and numbness are usually most prominent. Vascular signs are less common.3, 4, 5 Arterial compression can cause extrinsic
PATIENTS AND METHODS
This study includes a consecutive series of patients hospitalized in the vascular surgery departments of the Purpan University Hospital in Toulouse, France, and Pellegrin University Hospital in Bordeaux, France, for assessment or diagnosis of posttraumatic TOS between 1987 and 2002. A requirement for inclusion in this study was the presence of acquired bone lesions documented by plain radiography and/or computed tomography (CT).
Thirteen patients had the previously mentioned criteria. In some
RESULTS
This series includes 13 patients. There were seven men (54%) and six women (46%) with a mean age of 41 ± 16 years (Table I). These 13 patients accounted for less than 5% of the overall population treated for TOS during the same time period.
All patients were examined after the initial trauma period. The interval between the trauma event and management in the Vascular Surgery Department ranged from 1 month to 15 years. Most cases involved high-energy trauma, resulting from sports-related
DISCUSSION
TOS is rare. Trauma-related cases are still uncommon but represent a special form requiring specific therapeutic management. The objectives of clinical examination are to document previous trauma, confirm diagnosis of TOS by classic postural maneuvers, and detect complications such as distal ischemic signs, edema, and cyanosis of the upper extremity. For assessment of bone lesions, plain radiography can visualize pseudarthrosis, hypertrophic callus of the clavicle or first rib, and
CONCLUSIONS
Because the incidence of post-traumatic TOS is low, management is rarely required. However, surgeons should be aware of the special features of this entity. In this regard, the high incidence and severity of vascular lesions must be underscored, with special emphasis on the frequent association between pseudarthrosis of the clavicle and subclavian artery aneurysm. Subclavian artery aneurysm should be searched for in all patients with TOS in association with pseudarthrosis. Patients having
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Cited by (28)
Thoracic outlet syndrome due to first rib subluxation in a 69-year-old woman
2022, Annals of Vascular Surgery - Brief Reports and InnovationsThe emergency medicine management of clavicle fractures
2021, American Journal of Emergency MedicineCitation Excerpt :A thorough neurovascular and pulmonary examination to evaluate for associated injuries is important when a clavicle fracture is suspected or identified. Rib fractures, blunt cerebrovascular injury (BCVI) to the arteries of the neck and base of the skull, hemothorax, tracheal injury, esophageal injury, scapular fracture, and shoulder dislocation are other potential associated injuries [34,35,36,37,38,39,40]. In the ED, a single anteroposterior (AP) or posteroanterior (PA) radiograph of the clavicle is commonly obtained.
An unusual case of neurogenic thoracic outlet syndrome
2017, International Journal of Surgery Case ReportsCitation Excerpt :10% cases had supernumerary scalene muscles, and 8.5% cases were attributed to cervical rib [8]. Acquired causes of TOS include post-traumatic inflammation most commonly following hyperextension injury of the neck [9]. Lymphocele causing nTOS is an extremely rare condition, with only a single case report published so far in the literature [6].
Late recurrent peripheral upper limb ischemia after non-union of a clavicle fracture
2015, InjuryCitation Excerpt :In spite of the anatomic proximity with subclavian vessels (the mean distance of the bundle from the posterior border of the clavicle was found to be 9.2 mm) vascular injuries following clavicle fractures are uncommon. The majority of them are associated with a high-energy trauma mechanism, usually due to an acute tearing or compression exerted by fracture's fragments [5–9]. Late vascular complications are also rare but have been described in the literature; they can be secondary to a vascular compression applied by bony callus, mostly in case of malunion, or to a chronic injury to the vessels in case of non-union [10–13].
Blunt traumatic subclavian vein pseudoaneurysm
2015, Journal of Vascular Surgery CasesCitation Excerpt :Therefore, preoperative preparation of the thigh was done in case a great saphenous vein conduit was required. To our knowledge, this represents the second case of post-blunt traumatic subclavian venous pseudoaneurysm reported.13 The patient was successfully managed with surgical excision of the pseudoaneurysm through a supraclavicular approach.
Results of surgical treatment of thoracic outlet syndrome
2014, Angiologia
Presented at the Eighteenth Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, Toulouse, France, May 21–24, 2003.