1/21. Thoracic outlet compression syndrome. Forty-nine patients underwent sixty-four procedures for the treatment of the thoracic outlet compression syndrome. Detailed history and careful physical examination are of paramount importance in diagnosing this disease. Our findings strongly suggest that a positive arteriogram is confirmatory evidence of the thoracic outlet compression syndrome. Two problems are identified as the source of unsatisfactory results in this series: poor selection of patients and the regeneration of rib and dense scar tissue with recurrence of compression symptoms. We favor the transaxillary approach to resection of the first rib because it provides satisfactory exposure for removal of the entire rib and utilizes a more cosmetically pleasing incision. Division of muscles, traction on nerves, and entrance into a body cavity are not required, operating time and hospital stay are shortened, and blood loss is minimized. Favorable long-term results were seen in 86 per cent of the patients treated. ( info) |
2/21. Contralateral brachial plexus neuropathy after arthroscopic shoulder surgery. This case report presents a neurologic complication that occurred after shoulder arthroscopic surgery on the contralateral arm. This brachial plexus palsy has been documented as a reversible C7-T1 lesion, which was the consequence of the patient's unknown cervical rib and the applied lateral position during the operation. In this case, the recovery was almost complete within 3 months postoperatively; however, one should take care to prevent these complications with an appropriate positioning of patients with an anatomic variant. ( info) |
| cervical rib is a congenital phenomenon that usually occurs in association with upper-limb neurovascular symptoms. The presence of a cervical rib displaces the great vessels that cross the thoracic outlet superiorly and proceed into the neck. We report an unusual case of iatrogenic hemorrhage during a tracheostomy in a patient whose right subclavian artery had been displaced by a cervical rib. Our aim is to alert surgeons to the hidden risks of this phenomenon. ( info) |
4/21. exercise induced critical ischaemia of the upper limb secondary to a cervical rib. The case is reported of a 32 year old woman with acute on chronic upper limb ischaemia due to thrombus from a cervical rib that had compressed the right subclavian artery of her dominant hand after use of a rowing machine. If not detected early, this condition can be debilitating especially in the young. A multidisciplinary approach is advisable to ensure a satisfactory outcome. ( info) |
| 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. ( info) |
| Reported here is a 13-year-old girl suffering from pain in her right lower neck region and the shoulder for the preceding 2-3 years. She was diagnosed to have right thoracic outlet syndrome due to bifid ribs--caused by the bony fusion of the variant cervical rib. She was operated via supraclavicular approach, whereby the variant cervical rib and the fibrous bands were excised. She was found to be quite improved 1 month after surgery. thoracic outlet syndrome, a rare disease of childhood, is discussed in the light of the relevant literature. ( info) |
7/21. A case of isolated paralysis of serratus anterior. The authors present a case of isolated paralysis of the serratus anterior due to compression of the long thoracic nerve by a cervical rib. The clinical and diagnostic features are described. Removal of the vertical rib resulted in complete functional recovery of the muscle involved. ( info) |
| Compression by a cervical rib may result in neurologic and/or vascular symptoms. Two patients are reported with thoracic outlet syndrome (TOS) secondary to cervical rib. Both patients had vague shoulder pain as well as neurologic manifestations due to compression neuropathy of the lower trunk of the brachial plexus. One patient was suspected initially to have carpal tunnel syndrome. ( info) |
| A case of subclavian artery aneurysm secondary to a cervical supernumerary rib is reported in a 9-year-old boy. Such a complication in a cervical rib has never been reported in so young a child. The risk of inserting inextensible prosthetic material in a growing child led to regular supervision instead of an early surgical cure. ( info) |
| The authors present three cases of cervical ribs discovered by computerized tomography (CT). This represents, to the authors' knowledge, the first such report. The radiologic appearance and relevant clinical findings of cervical ribs will be discussed. ( info) |