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Complications of surgery for thoracic outlet syndrome
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
There remains some room for debate regarding the necessity for first rib resection during supraclavicular thoracic outlet decompression, with some advocating for routine first rib resection and others for a more selective approach based on intraoperative findings following scalenectomy and brachial plexus neurolysis alone.40 However, it remains unclear if there are any advantages to retaining the first rib, and incomplete first rib resection is often a factor contributing to recurrent neurogenic TOS.34–39 It is therefore recommended that first rib resection always be included in supraclavicular decompression for neurogenic TOS, extending posteriorly as far as the level of the T1 nerve root and anteriorly to the costochondral junction (just medial to the scalene tubercle) (Figure 28.5). The first rib is often abnormal in patients with a cervical rib, and may serve as a source of persistent/recurrent nerve compression after isolated cervical rib resection. Thus, first rib resection is also advocated in patients with cervical ribs, along with resection of the cervical rib, in order to ensure the most complete decompression feasible.41
Transaxillary Decompression of Thoracic Outlet Syndrome Patients Presenting with Cervical Ribs
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
The cervical rib is central to our understanding of thoracic outlet syndrome. In 1818, A.P. Cooper described the association of cervical ribs with the development of neurovascular symptoms in the same extremity.1 This was called the cervical rib syndrome. This was a seminal observation which has informed our understanding of compressive syndromes of nerves and blood vessels. Thus, when H. Coote resected a cervical rib (1861) via a transcervical approach,2 it was predicated on Cooper's observations. Since then, the resection of cervical ribs has most often been accomplished via the same approach used by Coote in 1861.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
A cervical rib is an extra rib, which arises from the 7th cervical vertebra. It is a congenital abnormality that is located above the 1st rib. Thoracic outlet syndrome is caused by compression of the lower trunk of the brachial plexus or subclavian artery. It is associated with the formation of subclavian aneurysms. Chest radiographs with apical lordotic views and cervical spine radiographs are recommended. Onset is from the second to eighth decade with a peak in the fourth decade. It is more common in females.
MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions
Published in Expert Review of Medical Devices, 2020
Alexander T. Mazal, Ali Faramarzalian, Jonathan D. Samet, Kevin Gill, Jonathan Cheng, Avneesh Chhabra
Bony abnormalities, such as cervical ribs or prominent C7 transverse processes, can also dispose to the development of TOS, although it is hypothesized that a superimposed regional injury must generally occur to precipitate symptoms (Figure 8). Indeed, in a study performed by Sanders and Hammond, neck trauma was the cause of neurogenic symptoms among 80% of patients with cervical or anomalous first ribs [80]. MRN can be used to identify nerve signal abnormalities in the setting of TOS, which manifest as regions of T2 signal hyperintensity, often in the lower trunk, with or without associated nerve enlargement [18]. Among conventional MRN sequences, Sagittal STIR (2D and 3D reconstruction) and axial T1 images are most useful for the evaluation of anatomic neurogenic compression.
An unusual cause of “traumatic” hemothorax: perforation of the lung parenchyma by a bifid rib
Published in Acta Chirurgica Belgica, 2020
Sander Ovaere, Anneleen Peeters, Lieven Depypere
Congenital anomalies of the ribs are relatively common, and they can be divided in numerical (for example cervical ribs) or structural abnormalities (for example bifid ribs) [1]. These anomalies are usually asymptomatic. Literature on symptomatic bifid ribs is limited [2–4]. Kamano and colleagues proposed a classification for intrathoracic bifid ribs in their review paper, with these images complying with a type two Kamano intrathoracic bifid rib [2]. The images of this case illustrate the unusual traumatic perforation of the lung caused by a bifid rib. The case illustrates that one might consider resection of an asymptomatic bifid rib when imaging suggests significant compression on the lung parenchyma.
Familial predisposition of thoracic outlet syndrome: does a familial syndrome exist? Report of cases and review of literature
Published in Acta Chirurgica Belgica, 2021
Jens Goeteyn, Niels Pesser, Bart van Nuenen, Marc van Sambeek, Joep Teijink
Three distinct types of thoracic outlet syndrome (TOS) exist: arterial thoracic outlet syndrome (ATOS), venous thoracic outlet syndrome (VTOS) and neurogenic thoracic outlet syndrome (NTOS) thoracic outlet syndrome, by compression of respectively artery, vein or plexus. Compression of the brachial plexus can be caused by fibromuscular ligaments, hypertrophic scalenus muscle, cervical ribs (CRs) or any other anatomic anomaly of the interscalene triangle, costoclavicular space or pectoralis minor space [1–4]. NTOS is the most prevalent type of TOS and accounts for 95% of all thoracic outlet syndrome patients [1,3–6].