Síndrome do desfiladeiro torácico neurogênica verdadeira: relato de caso / True neurogenic thoracic outlet syndrome

A síndrome do desfiladeiro torácico neurogênica verdadeira é uma condição rara, motivada pelo angustiamento do plexo braquial inferior e médio, quando da sua passagem por um reduzido espaço inter-escalênico. Os autores descrevem o caso de uma jovem de 16 anos que apresentou atrofia e fraqueza da mão direita de início insidioso e evolução progressiva. Seus exames neurológico, de imagem e eletroneuromiográfico apontaram para síndrome do desfiladeiro torácico neurogênica verdadeira à direita na presença de costela cervical bilateral. Num acompanhamento de 22 meses após a ressecção da costela cervical do lado sintomático, houve melhora da função motora mantendo-se amiotrofia tenar.

The true neurogenic thoracic outlet syndrome is a very rare condition caused by involvement of the inferior and medium brachial plexus cords in a reduced interscalenic space. The authors describe a 16-year-old girl with insidious wasting and progressive weakness of her right hand. Her neurologic examination, images, and eletroneuromiographic results point to a right side true neurogenic thoracic outlet syndrome with bilateral cervical rib. After a twenty-two months follow-up post right cervical rib resection, she feels better from the motor function aspect, but maintains tenar atrophy.

Type A Botulinum Toxin Therapy on Thoracic Outlet Syndrome: A case report

The true neurogenic thoracic outlet syndrome (TOS), one type of the TOS, has vague and controversial clinical symptoms, so a variety of diseases can mimic the presentation of TOS, especially ulnar neuropathy or cervical root lesion. For most patients with TOS, common practice is to offer a course of conservative treatment, but its kinds are not enough and pain is too severe to do that in the chronic state. We experienced a case of true neurogenic thoracic outlet syndrome with distinctive clinical symptom and abnormal electrodiagnostic findings. The symptom was not controlled by conservative management including oral medication or physical therapy. So we injected type A botulinum toxin (Botox(R)) in the scalene and pectoralis minor muscles with ultrasonography guide. After 2 weeks, the pain decreased in visual analogue scale nine to four, and the compliance to physical therapy was improved. The result appeared to demonstrate that botulinum toxin injection may be helpful in controlling symptoms and making the patient adapt in physical therapy in the difficult case to management by any other methods.