A number of patients with thoracic outlet syndrome experience intractable pain unresponsive to pharmacologic treatment. In this case, a brachia! plexus neurolysis was performed to address the patient's pain secondary to an enlarging left supraclavicular node. Guided under CT scan, 3 ml of 95% alcohol was injected in between the anterior and middle scalene muscles onto the trunks of the left brachia! plexus, affording immediate pain relief. Particular concerns of motor blockade, phrenic nerve palsy, stellate ganglion blockade, and bleeding did not occur. Therefore, brachia! plexus neurolysis can be safely done at a lower volume, without the above debilitating complications. It can be an option in relieving intractable upper extremity pain.
Brachial Plexus ; Thoracic Outlet Syndrome

The brachial plexus palsy is a rare complication of a clavicle fracture, occurring in 0.5% to 9.0% of cases. This condition is caused by excessive callus formation, which can be recovered by a spur resection and surgical fixation. In contrast, only seven cases have been reported after surgical reduction and fixation. A case of progressive brachial plexus palsy was observed after fixation of the displaced nonunion of a clavicle fracture. The symptom were improved after removing the implant.
Bony Callus ; Brachial Plexus Neuropathies ; Brachial Plexus ; Clavicle ; Paralysis ; Thoracic Outlet Syndrome

Thoracic outlet syndrome(TOS) are constellation of symptoms caused by compression of the neurovascular bundle including the brachial plexus, the subclavian artery and the subclavian vein at the thoracic outlet region. It includes neurogenic TOS, venus TOS, arterial TOS, and neurogenic TOS is the most common type. TOS has varied manifestations and lack of confirmatory testing, therefore, the diagnosis should be conbination with thorough history, physical examination and associated supplementary examinations. Conservative and surgical treatment can be choosed for TOS and the outcomes are generally good. Conservative management is the initial treatment strategy for neurogenic TOS. In cases of symptomatic vascular TOS and neurovascular TOS, which has been failed by conservative treatment, surgery should be considered more promptly.
Brachial Plexus ; Conservative Treatment ; Humans ; Physical Examination ; Thoracic Outlet Syndrome ; diagnosis ; therapy

Thoracic outlet syndrome is a relatively well known disease. Other than trauma, this disease is mostly caused by anatomical structures that cause vascular or neural compression. The cause of thoracic outlet syndrome is diverse; however, there are only few reports of thoracic outlet syndrome caused by lipoma in the pectoralis minor space. We report a case of compression of the lower trunk of brachial plexus in which a large lipoma that developed in the pectoral minor space grew into the subclavicular space, along with a review of literature.
Brachial Plexus ; Lipoma ; Nerve Compression Syndromes ; Thoracic Outlet Syndrome

In post-stroke patients, the pain or paresthesia of the affected limb is common. These symptoms may be caused by a variety of pathologic conditions. Considering the debilitating effects of the pain, it is important to determine the exact cause and manage appropriately. A 41-year-old woman who had experienced a hemorrhagic lesion in the right basal ganglia and corona radiata 4 months previously presented with an irritating tingling sensation in her left upper extremity. She failed to respond to a number of treatment options including medications and physical agent modalities. Following a diagnosis of disputed thoracic outlet syndrome (TOS) caused by scalene muscle dysfunctions, she received ultrasound-guided electrical twitch-obtaining intramuscular stimulation (ETOIMS) which significantly alleviated the pain. This case suggests that the disputed TOS should be considered as one of the possible causes of post-stroke pain, and that detailed history-taking and physical examination, as well as imaging or electrophysiological studies, might be required for accurate diagnosis. Furthermore, ultrasound-guided ETOIMS can be used as a safe and minimally invasive technique for the treatment of the disputed TOS with fewer systemic and local side effects.
Adult ; Basal Ganglia ; Diagnosis ; Extremities ; Female ; Humans ; Muscles* ; Paresthesia* ; Physical Examination ; Sensation ; Stroke ; Thoracic Outlet Syndrome ; Upper Extremity*

BACKGROUND: Surgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. In this study, we have compared the complications arising during the supraclavicular and the transaxillary approaches to determine the appropriate approach for TOS surgery. METHODS: In this study, 448 patients with symptoms of TOS were assessed. The male-to-female ratio was approximately 1:4, and the mean age was 34.5 years. Overall, 102 operations were performed, including unilateral, bilateral, and reoperations, and the patients were retrospectively evaluated. Of the 102 patients, 63 underwent the supraclavicular approach, 32 underwent the transaxillary approach, and 7 underwent the transaxillary approach followed by the supraclavicular approach. Complications were evaluated over 24 months. RESULTS: The prevalence of pneumothorax, hemothorax, and vessel injuries in the transaxillary and the supraclavicular approaches was equal. We found more permanent and transient brachial plexus injuries in the case of the transaxillary approach than in the case of the supraclavicular approach, but the difference was not statistically significant. Persistent pain and symptoms were significantly more common in patients who underwent the transaxillary approach (p<0.05). CONCLUSION: The supraclavicular approach seems to be the more effective technique of the two because it offers the surgeon better access to the brachial plexus and a direct view. This approach for a TOS operation offers a better surgical outcome and lower reoperation rates than the transaxillary method. Our results showed the supraclavicular approach to be the preferred method for TOS operations.
Brachial Plexus ; Hemothorax ; Humans ; Intraoperative Complications ; Methods ; Pneumothorax ; Prevalence ; Reoperation ; Retrospective Studies ; Thoracic Outlet Syndrome*

Thoracic outlet syndrome (TOS) is an uncommon condition that can occur when the nerves, artery, or vein to the arm is compressed by one or more of the structures that make up the thoracic outlet. TOS was the first compression neuropathy of the upper extremity to be identified. The wide variability of patients' symptoms, which include vascular and neural signs, as well as diffuse symptoms, and the lack of a valid and reliable test to confirm the diagnosis of TOS makes it difficult to identify correctly patients with TOS. Rates of three to 80 cases per 1,000 patients have been reported, but more patients are likely to have TOS because it is underestimated. Additionally, the primary controversy regarding patients with TOS is related to symptoms such as paresthesia, numbness, and pain. No positive objective test exists to confirm an accurate diagnosis. If patients present with diffuse pain and numbness in the neck and upper extremity with more than 2 provocation tests, TOS could be considered. The purpose of this review is to provide an overview of the causes, classification, evaluation, and management of TOS.
Arm ; Arteries ; Classification ; Diagnosis ; Humans ; Hypesthesia ; Neck ; Nerve Compression Syndromes ; Paresthesia ; Thoracic Outlet Syndrome* ; Upper Extremity ; Veins

PURPOSE: To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only. MATERIALS AND METHODS: Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0+/-10.5 years and duration of symptom was 12.2+/-8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients. RESULTS: After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection. CONCLUSION: Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus.
Adult ; Brachial Plexus/*drug effects ; Cross-Over Studies ; *Exercise Therapy ; Female ; Humans ; *Injections, Intramuscular ; Male ; Middle Aged ; Neck Muscles/drug effects ; Pain/drug therapy ; Pain Measurement ; Paresthesia/*drug therapy/rehabilitation ; Single-Blind Method ; Thoracic Outlet Syndrome/diagnosis/*drug therapy ; Treatment Outcome

PURPOSE: The aim of this study was to analyze the multiple factors as a cause of thoracic outlet syndrome (TOS) in specific industrial field which is a South Korea company manufacturing rolling stock, defense products and plant equipment. METHODS: We analyzed questionnaire survey of 30 patients diagnosed as TOS at outpatient department from January 2005 to October 2015 retrospectively. We reviewed clinical records and questionnaire about repetitive task related to microtrauma. Questionnaire was established to analyze the correlation between occupational history and TOS. Statistical test was done with multiple regression analysis. RESULTS: Incidence rate was 9%, all of 30 patients engaged in heavy workload with symptoms of pain in neck and shoulder. A multiple regression was run to predict arm visual analogue scale (VAS) score from age, force of work, time of work and career. The model of analysis for arm VAS was statistically significant, p<0.001, adjusted r²=0.489. Only force of work variable added was statistically significantly to the prediction, p<0.001. CONCLUSION: Prevalence of TOS in highly loaded industrial field is higher than typically known, appropriate diagnosis is important for early comeback to work. Aggressive diagnosis and treatment is important since non-operative treatment can have satisfying result for patient and help early comeback to work.
Arm ; Diagnosis ; Humans ; Incidence ; Korea ; Neck ; Occupational Diseases ; Outpatients ; Plants ; Prevalence* ; Retrospective Studies ; Shoulder ; Thoracic Outlet Syndrome*

Adult-onset brachial plexopathy can be classified into traumatic and non-traumatic aetiologies. Traumatic brachial plexopathies can affect the pre- or postganglionic segments of the plexus. Non-traumatic brachial plexopathies may be due to neoplasia, radiotherapy, thoracic outlet syndrome and idiopathic neuralgic amyotrophy. Conventional magnetic resonance imaging (MRI) is useful to localise the area of injury or disease, and identify the likely cause. This review discusses some of the common causes of adult-onset brachial plexopathy and their imaging features on MRI. We also present a series of cases to illustrate some of these causes and their MRI findings.
Adult ; Aged ; Brachial Plexus ; anatomy & histology ; diagnostic imaging ; Brachial Plexus Neuropathies ; diagnostic imaging ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Thoracic Outlet Syndrome ; diagnostic imaging ; therapy ; Wounds and Injuries ; diagnostic imaging