Modern Treatment of Neurogenic Thoracic Outlet Syndrome: Pathoanatomy, Diagnosis, and Arthroscopic Surgical Technique
J Hand Surg Glob Online. 2023 Jan 18;5(4):561-576. doi: 10.1016/j.jhsg.2022.07.004. eCollection 2023 Jul.ABSTRACTCompressive pathology in the supraclavicular and infraclavicular fossae is broadly termed "thoracic outlet syndrome," with the large majority being neurogenic in nature. These are challenging conditions for patients and physicians and require robust knowledge of thoracic outlet anatomy and scapulothoracic kinematics to elucidate neurogenic versus vascular disorders. The combination of repetitive overhead activity and scapular dyskinesia leads to contracture of the scalene muscles, subclavius, and pectoralis mino...
Source: Hand Surgery - July 31, 2023 Category: Surgery Authors: Adil S Ahmed Thibault Lafosse Alexander R Graf Anthony L Karzon Michael B Gottschalk Eric R Wagner Source Type: research
Surgical Approaches for Thoracic Outlet Syndrome: A Review of the Literature
J Hand Surg Glob Online. 2022 May 5;5(4):577-584. doi: 10.1016/j.jhsg.2022.04.007. eCollection 2023 Jul.ABSTRACTThoracic outlet syndrome (TOS) is caused by entrapment of the neurovascular bundle in the interscalene, costoclavicular, or subpectoral minor space. Compression in the interscalene or costoclavicular space with the first rib and scalene muscle leads to vascular and neurogenic TOS, whereas compression in the subpectoral minor space leads to pectoralis minor syndrome. Various surgical approaches exist for the treatment of TOS. The introduction and development of surgical approaches have minimized surgical invasiven...
Source: Hand Surgery - July 31, 2023 Category: Surgery Authors: Taku Suzuki Hiroo Kimura Noboru Matsumura Takuji Iwamoto Source Type: research
Modern Treatment of Neurogenic Thoracic Outlet Syndrome: Pathoanatomy, Diagnosis, and Arthroscopic Surgical Technique
J Hand Surg Glob Online. 2023 Jan 18;5(4):561-576. doi: 10.1016/j.jhsg.2022.07.004. eCollection 2023 Jul.ABSTRACTCompressive pathology in the supraclavicular and infraclavicular fossae is broadly termed "thoracic outlet syndrome," with the large majority being neurogenic in nature. These are challenging conditions for patients and physicians and require robust knowledge of thoracic outlet anatomy and scapulothoracic kinematics to elucidate neurogenic versus vascular disorders. The combination of repetitive overhead activity and scapular dyskinesia leads to contracture of the scalene muscles, subclavius, and pectoralis mino...
Source: Hand Surgery - July 31, 2023 Category: Surgery Authors: Adil S Ahmed Thibault Lafosse Alexander R Graf Anthony L Karzon Michael B Gottschalk Eric R Wagner Source Type: research
Low-dose apixaban or rivaroxaban as secondary prophylaxis of upper extremity deep vein thrombosis
AbstractUpper extremity deep vein thrombosis (UEDVT) may occur without inciting factor or may be secondary to malignancy, surgery, trauma, central venous catheter or related to thoracic outlet syndrome (TOS). International guidelines recommend anticoagulant treatment for at least three months, in particular the use of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). No data on extended anticoagulant therapy and reduced dose of DOACs have been reported in patients affected by UEDVT with persistent thrombotic risk (active cancer, major congenital thrombophilia) or without affected vein recanalization. In ...
Source: Journal of Thrombosis and Thrombolysis - July 12, 2023 Category: Hematology Source Type: research
Technical Aspects of Robotic First Rib Resection
Robot-assisted thoracoscopic surgery for the treatment of thoracic outlet syndrome is a novel approach that continues to increase in popularity due to advantages compared with traditional open first rib resection. Following publication of the Society of Vascular Surgeons expert statement in 2016, the diagnosis and management of thoracic outlet syndrome is favorably evolving. Technical mastery of the operation requires precise knowledge of anatomy, comfort with robotic surgical platforms, and understanding of the disease. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - May 25, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Matthew R.L. Egyud, Scott Holmes, Bryan M. Burt Source Type: research
Thoracic outlet syndrome: a retrospective analysis of robotic assisted first rib resections
AbstractThoracic Outlet Syndrome (TOS) is caused by compression of the neurovascular bundle between the first rib and the clavicula, which can cause a large panel of symptoms and has a reported incidence of approximately 2 –4/100.000. Surgical treatment consists of the resection of the first rib and is historically performed using an open, mainly transaxillary, approach. Recent developments resulted in a minimally invasive approach using Robotic Assisted Thoracic Surgery (RATS). With this study, the investigators wa nt to provide a descriptive study of first rib resection using RATS approach at two different centers. We ...
Source: Journal of Robotic Surgery - May 24, 2023 Category: Surgery Source Type: research
Systematic Review on Botulinum toxin injections as diagnostic or therapeutic tool in Thoracic Outlet Syndrome
The optimal diagnostic and treatment algorithm for patients with suspected thoracic outlet syndrome (TOS) remains challenging. Botulinum toxin (BTX) muscle injections have been suggested to shrink muscles in the thoracic outlet reducing neurovascular compression. This systematic review evaluates the diagnostic and therapeutic value of BTX injections in TOS. (Source: Annals of Vascular Surgery)
Source: Annals of Vascular Surgery - May 24, 2023 Category: Surgery Authors: Mert K ök, Ludo Schropp, Irene C. van der Schaaf, Evert-Jan Vonken, Eline S. van Hattum, Gert J. de Borst, Bart-Jeroen Petri Tags: General Review Source Type: research
Rapid Recovery After Thoracic Outlet Decompression in a Series of Adolescent Athletes With Chronic Atraumatic Shoulder-Girdle Pain, Scapular Winging/Dyskinesis, and Normal Electrodiagnostic Studies
We describe a group of adolescent athletes with this clinical presentation but normal EDX, followed by later development of neurogenic thoracic outlet syndrome (NTOS). (Source: Journal of Vascular Surgery)
Source: Journal of Vascular Surgery - May 23, 2023 Category: Surgery Authors: Jackson S. Burton, Susan E. Mackinnon, Paul B. McKee, Karen M. Henderson, Danita M. Goestenkors, Robert W. Thompson Tags: Interactive Poster Session Source Type: research
Infraclavicular Approach and Adjunctive Strategies for the Management of Venous Thoracic Outlet Syndrome
We report midterm follow-up for the IC approach for the treatment of acute VTOS. (Source: Journal of Vascular Surgery)
Source: Journal of Vascular Surgery - May 23, 2023 Category: Surgery Authors: Christopher A. Cappellini, Douglas Troutman, Matthew Carpiniello, Matthew Dougherty, Keith Calligaro Tags: Interactive Poster Session Source Type: research
Analysis of Completion Intraoperative Venography Findings During First Rib Resection for Venous Thoracic Outlet Syndrome
Traditional treatment of venous thoracic outlet syndrome (vTOS) is first rib resection (FRR) and subclavian venolysis followed by interval venography with possible angioplasty. Completion intraoperative venography has emerged as an effective alternative, but clinical outcomes have yet to be correlated with operative findings. The goal of the current study was to review our institutions ’ use of completion intraoperative venography and analyze outcomes based on venographic findings. (Source: Journal of Vascular Surgery)
Source: Journal of Vascular Surgery - May 23, 2023 Category: Surgery Authors: Brandon Creisher, Julian Jackson, Simona Sica, Enrica Rossini, Dawn M. Salvatore, Michael J. Nooromid, Babak Abai, Paul J. DiMuzio Tags: Interactive Poster Session Source Type: research
Novel Ultrasound-guided Injection Method for Thoracic Outlet Syndrome Based on Anatomical Features: A Cadaveric Study
CONCLUSION: According to anatomical features, the appropriate location for botulinum neurotoxin injection in the AS and MS muscles for the treatment of TOS is the lower portion of the scalene muscles. Therefore, it is recommended to inject at a depth of approximately 8 mm for AS and 11 mm for MS at a point 3 cm above the clavicle.PMID:37192239 (Source: Pain Physician)
Source: Pain Physician - May 16, 2023 Category: Anesthesiology Authors: Kyu-Lim Lee Ji-Hyun Lee Hye-Won Huh Hee-Jin Kim Source Type: research
Robotic First Rib Resection Utilizing the Da Vinci Xi System
Thoracic outlet syndrome (TOS) is a relatively rare but debilitating disease primarily effecting young adults. Surgical resection of the first rib is an effective treatment for clinically apparent TOS. The Xi robotic platform allows for superior visualization of the first rib during resection as well as continuous and improved visualization of the neuro-vasculature without the need for potentially harmful retraction of these vital structures. Fine dissection is easily accomplished with the robotic instruments with greater ease than that experienced with non-robotic thoracoscopic approaches. (Source: Operative Techniques in...
Source: Operative Techniques in Cardiac and Thoracic Surgery - May 13, 2023 Category: Cardiovascular & Thoracic Surgery Authors: John Paul Kuckelman, M. Blair Marshall Tags: Thoracic Source Type: research
Endoscopic-assisted Infraclavicular Approach for First-Rib Resection in Neurologic Thoracic Outlet Syndrome: A Report of Two Cases
J Hand Surg Asian Pac Vol. 2023 Apr;28(2):287-291. doi: 10.1142/S2424835523720086. Epub 2023 Apr 17.ABSTRACTVarious reported surgical approaches for the treatment of thoracic outlet syndrome (TOS) exist and no firm evidence exists for any approach. A 16-year-old and a 29-year-old male presented with numbness in the upper limb. Neurologic TOS was diagnosed, and surgery was planned for the resection of the first rib and scalene muscles. Through an infraclavicular incision, open resection of the anterior scalene muscle and the anterior aspect of the first rib was performed. With the assistance of endoscopy, the middle scalene...
Source: Hand Surgery - April 29, 2023 Category: Surgery Authors: Taku Suzuki Hiroo Kimura Noboru Matsumura Takuji Iwamoto Source Type: research
Considerations for Surgical Treatment of Neurogenic Thoracic Outlet Syndrome: A Meta-Analysis of Patient-Reported Outcomes
CONCLUSIONS: Mean differences in Disabilities of the Arm, Shoulder and Hand scores and Derkash scores were significantly better for RSS. Higher complication rates were reported after the first rib resection. Our findings suggest that RSS is an effective option for the treatment of nTOS.TYPE OF STUDY/ LEVEL OF EVIDENCE: Therapeutic IV.PMID:37055338 | DOI:10.1016/j.jhsa.2023.03.005 (Source: Hand Surgery)
Source: Hand Surgery - April 13, 2023 Category: Surgery Authors: Mario Blondin Garrett L Garner Keegan M Hones David Spencer Nichols Elizabeth A Cox Harvey Chim Source Type: research
Considerations for Surgical Treatment of Neurogenic Thoracic Outlet Syndrome: A Meta-Analysis of Patient-Reported Outcomes
It remains unclear whether the first rib resection, performed via a supraclavicular (SCFRR) or transaxillary (TAFRR) approach, is necessary for patients with neurogenic thoracic outlet syndrome (nTOS). In a systematic review and meta-analysis, we performed a direct comparison of patient-reported functional outcomes following different surgical approaches for nTOS. (Source: The Journal of Hand Surgery)
Source: The Journal of Hand Surgery - April 11, 2023 Category: Surgery Authors: Mario Blondin, Garrett L. Garner, Keegan M. Hones, David Spencer Nichols, Elizabeth A. Cox, Harvey Chim Tags: Editor's Choice Source Type: research
