RESUMEN
Congenital brachial plexus palsy (CBPP) usually occurs secondarily to intrapartum trauma, but this is not always the case. Cervical ribs have previously been reported to increase the risk of CBPP in association with birth trauma. We report the cases of two children (one female, one male) with congenital lower brachial plexus palsy in whom the presence of non-ossified cervical ribs was the only identified risk factor. In the female child magnetic resonance imaging (MRI) of the brain, spinal cord, and brachial plexus revealed no abnormality except for the presence of bilateral cervical ribs at the level of the seventh cervical (C7) vertebra. Chest radiography was normal, which suggested that the cervical ribs identified on the MRI were fibrous bands or cartilaginous ribs rather than ossified ribs. In the male child, MRI of the spine and brachial plexus was normal but he was noted to have bilateral cervical ribs at C7. These were not identifiable on chest radiography and, therefore, are likely to reflect fibrous bands or cartilaginous ribs.
Asunto(s)
Neuropatías del Plexo Braquial/congénito , Síndrome de la Costilla Cervical/congénito , Costilla Cervical/anomalías , Neuropatías del Plexo Braquial/diagnóstico , Neuropatías del Plexo Braquial/fisiopatología , Costilla Cervical/fisiopatología , Síndrome de la Costilla Cervical/diagnóstico , Síndrome de la Costilla Cervical/fisiopatología , Preescolar , Electromiografía , Femenino , Estudios de Seguimiento , Antebrazo/inervación , Mano/inervación , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Nervio Mediano/fisiopatología , Debilidad Muscular/congénito , Debilidad Muscular/diagnóstico , Debilidad Muscular/fisiopatología , Atrofia Muscular/congénito , Atrofia Muscular/diagnóstico , Atrofia Muscular/fisiopatología , Conducción Nerviosa/fisiología , Examen Neurológico , Nervio Cubital/fisiopatologíaRESUMEN
Analysed herein are the findings of examination and outcomes of surgical management of fifty-eight patients (25 men and 33 women) presenting with Falconer-Weddel's costoclavicular syndrome in which the subclavian artery and vein and the brachial plexus at the thoracic outlet appear to be compressed. Of the 58 patients,five subjects were found to have a rudimentary cervical rib and three more (5.3%) patients had trophic disorders on their digits fingers: dystrophy of the nail plates, their fragility, periodically opening trophic ulcers at the digital tips and one patient presented with gangrene of the inguinal phalanx of the middle finger. Three patients had hyperemia of the face. A further four patients had roughening, hyperkeratosis of the skin of the hands, cracks. The presence of the supernumerary ribs was determined roentgenologically. Haemodynamics was studied using Doppler ultrasonography making it possible to reveal disordered blood flow in the upper-limb arteries in the physiological position assumed, in the Adson test as well as with Raynaud syndrome, which was observed in 39 patients. The function of the nerves was studied using electroneuromyography (ENMG). All patients were operated on under endotracheal anaesthesia. Decompression-medical operations were carried outperformed in all 58 patients, with the following four types of interventions being performed: transaxillary resection of the first rib combined with sympathectomy carried out in 23 patients, resection of the first rib without sympathectomy in eighteen patients, resection of the first rib via a surpraclavicular approach in four patients, scalenotomy and selective cervicothoracic sympathectomy in 13 patients.
Asunto(s)
Costilla Cervical , Síndrome del Desfiladero Torácico/cirugía , Costilla Cervical/diagnóstico por imagen , Costilla Cervical/fisiopatología , Síndrome de la Costilla Cervical/complicaciones , Síndrome de la Costilla Cervical/diagnóstico , Síndrome de la Costilla Cervical/diagnóstico por imagen , Síndrome de la Costilla Cervical/fisiopatología , Síndrome de la Costilla Cervical/cirugía , Descompresión Quirúrgica , Electromiografía , Femenino , Hemodinámica , Humanos , Masculino , Radiografía , Enfermedad de Raynaud/diagnóstico , Simpatectomía , Síndrome del Desfiladero Torácico/complicaciones , Síndrome del Desfiladero Torácico/diagnóstico , Síndrome del Desfiladero Torácico/diagnóstico por imagen , Síndrome del Desfiladero Torácico/fisiopatologíaRESUMEN
OBJECTIVE: Despite the relatively high incidence of the thoracic outlet syndrome, diagnostic criteria, role of surgery and optimal operative approach remain controversial. The main goal of the current study is to determine the long-term outcome of operative treatment of a series of patients with non-specific neurogenic thoracic outlet syndrome. METHODS: A retrospective study of a consecutive group of patients with thoracic outlet syndrome was carried out. The indications for surgery relied on clinical examination. Patients with diffuse pain were excluded. In all cases, the supraclavicular approach was used. Main outcome measures were neurological status and subjective complains. RESULTS: Nineteen patients have been operated over a period of 5 years. Total number of surgeries was 23. Pain and paresthesia on exertion were the leading symptoms in all cases. The causes of thoracic outlet syndrome were fibromuscular compression in 43.5%, cervical rib alone or in combination with a fibromuscular component in 30.4% and the first rib in 26.1%. The average follow-up was 36.3 months. In 91.7%, improvement of at least 50% was observed; 20.8% of the patients were completely symptom-free, and in 25%, the improvement was 90%. Recovery of the pre-operative motor weakness was recorded in 66.6%. The mortality and the permanent morbidity rates of the procedure were 0%. DISCUSSION: Operative decompression of the brachial plexus via the supraclavicular approach in patients with non-specific neurogenic thoracic outlet syndrome is a safe procedure that leads to a significant neurological improvement and amelioration of complains. The indication for surgery should be based chiefly on the neurological and clinical findings.
Asunto(s)
Neuropatías del Plexo Braquial/cirugía , Descompresión Quirúrgica/métodos , Procedimientos Neuroquirúrgicos/métodos , Cavidad Torácica/cirugía , Síndrome del Desfiladero Torácico/cirugía , Adulto , Neuropatías del Plexo Braquial/patología , Neuropatías del Plexo Braquial/fisiopatología , Síndrome de la Costilla Cervical/patología , Síndrome de la Costilla Cervical/fisiopatología , Síndrome de la Costilla Cervical/cirugía , Descompresión Quirúrgica/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Debilidad Muscular/etiología , Debilidad Muscular/fisiopatología , Debilidad Muscular/cirugía , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Estudios Retrospectivos , Cavidad Torácica/patología , Cavidad Torácica/fisiopatología , Síndrome del Desfiladero Torácico/patología , Síndrome del Desfiladero Torácico/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Most patients with thoracic outlet syndrome (TOS) present with exercise-induced upper extremity paresthesia. Neurogenic TOS is the most common type where the brachial nerve plexus is compressed against a tight thoracic outlet. Vascular compromise although rare can result from thoracic outlet pressure against the subclavian artery or more commonly the subclavian vein. This article reviews the pathophysiology of TOS and describes several effective surgical interventions. Complete first rib resection with surgical decompression is an essential part of the treatment for TOS. First rib resection via supraclavicular or a preferred transaxillary route should be considered when conservative modalities provide no symptom improvement.
Asunto(s)
Síndrome de la Costilla Cervical/cirugía , Síndrome de la Costilla Cervical/fisiopatología , Descompresión Quirúrgica , Humanos , Complicaciones PosoperatoriasRESUMEN
We report a case of bilateral neurogenic thoracic outlet syndrome (TOS). Electrophysiological examination suggested the presence of bilateral lower brachial plexus neuropathy. Radiography showed rudimentary bilateral cervical ribs. In the cases reported in the literature to date, the clinical findings are typically unilateral despite the common presence of bilateral bony abnormalities. Neurogenic TOS should be considered in young women, even if they present with bilateral symptoms, when they have occupations requiring strenuous activity of the upper limbs.
Asunto(s)
Síndrome de la Costilla Cervical/patología , Errores Diagnósticos/prevención & control , Lateralidad Funcional/fisiología , Costillas/anomalías , Síndrome del Desfiladero Torácico/patología , Adolescente , Neuropatías del Plexo Braquial/etiología , Neuropatías del Plexo Braquial/patología , Neuropatías del Plexo Braquial/fisiopatología , Síndrome de la Costilla Cervical/diagnóstico por imagen , Síndrome de la Costilla Cervical/fisiopatología , Vértebras Cervicales/anomalías , Vértebras Cervicales/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Mano/inervación , Mano/patología , Mano/fisiopatología , Humanos , Neuropatía Mediana/diagnóstico , Atrofia Muscular/etiología , Costillas/diagnóstico por imagen , Factores Sexuales , Síndrome del Desfiladero Torácico/diagnóstico por imagen , Síndrome del Desfiladero Torácico/fisiopatología , Tomografía Computarizada por Rayos X , Síndromes de Compresión del Nervio Cubital/diagnósticoRESUMEN
The work describes the origen, branching and distribution of aortic branches, during the development of the armadillho, experimental model in the studt of human leprosy. Using contrast injection, the branches of the subclavial, common carotid and omocervical aa. were identified as to its cooperation in irrigation of the ventral, lateral, dorsal, costal cervicals regions, encephalic and the thyroid gland
Asunto(s)
Humanos , Aorta/inervación , Síndrome de la Costilla Cervical/fisiopatología , Síndrome de la Costilla Cervical/rehabilitaciónRESUMEN
Eighteen cases of cervical Ribs causing numbness, paraesthesia and wasting of hand muscles were seen during the years 1990 to 1999 in neurosurgery unit of Tikur Anbessa, a central, referral teaching hospital. There were thirteen cases of unilateral, and 5 bilateral brachialgic pains M:F = 1:2 with ages range from 15-50 yrs (mean age 32 +/- 4.8 yrs); though it is 3 times common in women specially those with neurologic symptoms. 5 cases didn't have any cervical ribs. All had respective cervical rib resections and scalenotomy done. Paraesthesia and pain were relieved in about 90% of the cases. Cervical rib causing Thoracic Outlet Syndrome (TOS) is a rare condition commonly seen in less than 1% of the population as seen here in 18 cases in 10 years period. The absence of cervical rib doesn't rule out thoracic outlet syndrome as it can be from anomalous first ribs, scalenus anticus syndrome or congenital fibromuscular bands. Surgical excision has a good neurological outcome. No subclavian vessel especially arterial compression cases were seen in this study as cervical ribs can cause neurovascular compression. The diagnostic and therapeutic measures are clearly stated as this syndrome is a diagnostic and treatment challenge to the practicing general surgeons. Accurate diagnosis and proper surgical intervention are very crucial for the good outcome.
Asunto(s)
Síndrome de la Costilla Cervical/cirugía , Síndrome del Desfiladero Torácico/cirugía , Adolescente , Adulto , Síndrome de la Costilla Cervical/complicaciones , Síndrome de la Costilla Cervical/fisiopatología , Descompresión Quirúrgica , Etiopía , Femenino , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Parestesia , Síndrome del Desfiladero Torácico/etiología , Síndrome del Desfiladero Torácico/fisiopatología , Procedimientos Quirúrgicos Torácicos , Factores de TiempoAsunto(s)
Síndrome de la Costilla Cervical/diagnóstico , Síndrome de Abducción Dolorosa del Hombro/diagnóstico , Dolor de Hombro/etiología , Adulto , Síndrome de la Costilla Cervical/fisiopatología , Síndrome de la Costilla Cervical/rehabilitación , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lesiones del Manguito de los RotadoresAsunto(s)
Síndrome del Desfiladero Torácico/etiología , Síndrome de la Costilla Cervical/diagnóstico , Síndrome de la Costilla Cervical/fisiopatología , Síndrome de la Costilla Cervical/cirugía , Electrofisiología , Humanos , Síndrome del Desfiladero Torácico/fisiopatología , Síndrome del Desfiladero Torácico/cirugíaRESUMEN
We have attempted throughout this review to identify the issues surrounding thoracic outlet syndrome as well as to highlight their origins. It should be clear that many aspects of TOS remain controversial from the definition of the entity through pathogenesis, diagnosis, and treatment. The conflicts surrounding TOS are underlined most poignantly in the many letters to the editor of the New England Journal of Medicine in response to Urschel's 1972 publication. It is incumbent upon those of us who treat patients with TOS to dispel the ignorance surrounding this syndrome with astute, accurate, and reproducible observations. We must clearly define TOS as a clinical entity such that we may analyze the characteristics of the patients we treat. We must continue to search for innovative and specific diagnostic criteria. We must quantitatively and reproducibly measure subjective end points of pain severity and quality of life. The use of these methods will provide yardsticks for therapeutic success and act as determinants for the natural history of TOS. The objectives of treatment will remain the alleviation of symptoms and the restoration of function. We have applied these principles to the formulation of a protocol in which we record, in a prospective manner, both routine and innovative clinical parameters. With quantification of subjective end points, we may be able to correlate clinical presentation with outcome. We also may be able to define with some accuracy this entity we call thoracic outlet syndrome.
Asunto(s)
Regeneración Nerviosa/fisiología , Síndrome del Desfiladero Torácico/cirugía , Síndrome de la Costilla Cervical/fisiopatología , Síndrome de la Costilla Cervical/cirugía , Diagnóstico Diferencial , Humanos , Examen Neurológico , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Recurrencia , Reoperación , Raíces Nerviosas Espinales/fisiopatología , Raíces Nerviosas Espinales/cirugía , Síndrome del Desfiladero Torácico/fisiopatologíaRESUMEN
Neurosurgeons have for the most part abdicated a role in thoracic outlet surgery and have left the diagnosis and treatment of these patients to thoracic, vascular, and general surgeons. We view this as unfortunate. Neurosurgeons are well-positioned to diagnose these conditions. The major source of confusion with regard to diagnosis is cervical spine disease or peripheral nerve entrapment diseases with which neurosurgeons are quite familiar. Orthopedic consultations with regard to shoulder pathology are encouraged. The supraclavicular approach to treatment is one with which most neurosurgeons will be comfortable. However, the transaxillary approach is also one which neurosurgeons should be able to master readily. Working with long instruments in deep holes is a familiar surgical environment. It should be stressed, however, that part of the reason for the controversy concerning TOS stems from the fact that the morbidity rate from the transaxillary approach is high in some centers. We believe this results from inadequate technique. Neurosurgeons with training that emphasizes a high regard for neural tissue should be able to master both approaches. Thoracic outlet syndrome is a disease that most neurosurgeons will see on a regular basis. Thus, it needs to be recognized, and patients need to be analyzed from a neurologic perspective. The differential diagnosis should be considered thoughtfully. Operative intervention by experienced surgeons in properly selected patients will yield satisfying results.
Asunto(s)
Regeneración Nerviosa/fisiología , Síndrome del Desfiladero Torácico/cirugía , Plexo Braquial/fisiopatología , Neuritis del Plexo Braquial/fisiopatología , Neuritis del Plexo Braquial/cirugía , Síndrome de la Costilla Cervical/fisiopatología , Síndrome de la Costilla Cervical/cirugía , Diagnóstico Diferencial , Humanos , Microcirugia , Transmisión Sináptica/fisiología , Síndrome del Desfiladero Torácico/fisiopatologíaAsunto(s)
Atrofia Muscular/fisiopatología , Síndrome del Desfiladero Torácico/fisiopatología , Adolescente , Adulto , Síndrome de la Costilla Cervical/fisiopatología , Síndrome de la Costilla Cervical/cirugía , Electromiografía , Femenino , Mano , Humanos , Masculino , Persona de Mediana Edad , Conducción NerviosaAsunto(s)
Síndrome de la Costilla Cervical/patología , Trastornos Somatomorfos/diagnóstico , Síndrome del Desfiladero Torácico/patología , Adolescente , Adulto , Anciano , Síndrome de la Costilla Cervical/fisiopatología , Síndrome de la Costilla Cervical/psicología , Diagnóstico Diferencial , Femenino , Cefalea/etiología , Cefalea/psicología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Columna Vertebral/complicaciones , Enfermedades de la Columna Vertebral/diagnósticoAsunto(s)
Síndrome de la Costilla Cervical/fisiopatología , Manejo del Dolor , Síndrome del Desfiladero Torácico/fisiopatología , Síndrome de la Costilla Cervical/terapia , Enfermedad Coronaria/complicaciones , Humanos , Manipulación Ortopédica , Trastornos del Movimiento/terapia , Articulaciones Esternocostales/fisiopatologíaRESUMEN
In 14 patients with wasting of the hand due to a cervical rib and band, motor and sensory conduction studies on the peripheral parts of the median and ulnar nerves were helpful in establishing the correct diagnosis. The median nerve findings excluded carpal tunnel syndrome even when the clinical pattern of wasting in the hand suggested this diagnosis. Preservation of conduction velocity in the ulnar nerve excluded ulnar entrapment at the elbow; the reduced amplitude of the ulnar sensory action potentials (SAPs) indicated that the lesion was distal to the dorsal root ganglia. In 3 patients with ulnar SAP amplitudes that were low but not clearly abnormal, the level of the lesion was confirmed by a reduced response to intradermal injection of histamine on the inner side of the forearm.