ABSTRACT
BACKGROUND: Thoracic outlet syndrome (TOS) refers to a group of complex symptoms in the upper extremity caused by compression of the brachial plexus, subclavian artery and vein. Different surgical approaches were described for the management of TOS. There is, however, no "gold standard" procedure for this complicated and multidisciplinary problem. OBJECTIVES: This study evaluated the effectiveness of a microsurgical neurovascular decompression in the treatment of TOS. METHODS: 11 patients suffering from TOS (for 1.3 to 15 years after the beginning of the symptoms) were selected for a treatment of the complex symptoms of pain (diffuse or irradiated to the arm and hand), aching or paresthesia in the neck, shoulder, anterior chest, upper extremity and hand. Four of the 11 patients were suffering from signs of vascular compression. Eight patients showed slow progressive neurological deterioration (distribution of the ulnar nerve) with partial muscle atrophy. Patients underwent a microsurgical treatment using a supraclavicular approach followed by brachial plexus neurolysis, scalenectomy and release of the subclavian artery and vein without rib resection. Postoperative results were classified, using Am. J. Surg. (176: 215-218, 1998) scale (4), as good, fair and poor. RESULTS: Surgical results were studied, with a follow-up of 24 to 48 months. Prior to surgery, all patients had partial or severe limitation in physical activities. Post-operative follow-up showed that 9 (82%) of the 11 patients returned to normal everyday physical activities with a complete or significant relief of the symptoms (good results). In 2 patients (18%) the pain decreased and the use of medication was reduced (fair results). Eight of the 11 patients returned to full or partial employment. There were no cases of poor results in the study. CONCLUSION: Microsurgical neurovascular decompression of TOS without a removal of the cervical or first rib using a supraclavicular approach is an effective treatment method for a relief or complete release from symptoms and allows most patients to return to an active normal life.
Subject(s)
Decompression, Surgical , Microsurgery , Neurosurgical Procedures , Thoracic Outlet Syndrome/surgery , Vascular Surgical Procedures , Action Potentials , Adolescent , Adult , Employment , Female , Follow-Up Studies , Humans , Male , Motor Activity , Muscle, Skeletal/physiopathology , Postoperative Care , Postoperative Period , Prospective Studies , Thoracic Outlet Syndrome/physiopathology , Treatment OutcomeABSTRACT
The results of surgical treatment for arthritis of the first carpometacarpal joint using Kessler's silicone implant were examined in a group of 23 patients. The mean follow-up period was 24 months. Pain relief was obtained in 18 patients (78 per cent), functional improvement in daily activities in 16 patients, and power of pinch and power of grasp were improved in 10 out of 13 patients. Limitation of abduction complicated surgery in 6 patients. A high incidence of subluxation was found without correlation to the subjective results. Most of our patients were satisfied with the functional end results.
