Arthroscopic Pectoralis Minor Release and Infraclavicular Brachial Plexus Decompression for Neurogenic Thoracic Outlet Syndrome: A Novel Treatment for an Old Problem.
Endoscopic pectoralis minor release gives good-to-excellent outcomes in most infraclavicular nTOS patients
Arthroscopic Pectoralis Minor Release and Infraclavicular Brachial Plexus Decompression for Neurogenic Thoracic Outlet Syndrome: A Novel Treatment for an Old Problem.
Neurogenic thoracic outlet syndrome (nTOS) of infraclavicular etiology is a complex condition involving the compression of the brachial plexus through the interscalene triangle and costoclavicular, infraclavicular, and pectoralis minor space.
The purpose of this study was to analyze clinical outcomes of this technique compared with historically published outcomes for open first rib resection (first rib resection) and/or scalenectomy.
All patients who underwent endoscopic surgical decompression for nTOS of infraclavicular etiology were retrospectively reviewed at a single institution.
9 in 10 patients had good to excellent shoulder outcomes after surgery
Patients showed significant improvement in visual analog scale pain (7.0-2.1) and single alpha-numeric evaluation scores (37% to 84%).
There were no major complications and only 2 minor ones (one wound infection and one case of adhesive capsulitis).
Satisfaction and Derkash scores among patients undergoing endoscopic surgery were comparable with previously published studies on open first rib resection and scalenectomy, with lower rates of major complications and equivalent or improved clinical outcomes.
Endoscopic pectoralis minor release and infraclavicular brachial plexus decompression is a viable and effective treatment option for nTOS of infraclavicular etiology driven by the pectoralis minor and associated scapular girdle dyskinesia.
This cohort demonstrates improvements in clinical outcomes comparable with open scalenectomy and first rib resection with high patient satisfaction and no major neurologic, vascular, or thoracic complications.
LEVEL OF EVIDENCE: Therapeutic Level IV-Case Series.