Compression of the lower trunk of the brachial plexus by a cervical rib in two adolescent girls: case reports and surgical treatment

Lars B Dahlin; Clas Backman; Henrik Düppe; Harukazu Saito; Anette Chemnitz; Kasim Abul-Kasim; Pavel Maly

doi:10.1186/1749-7221-4-14

Journal of Brachial Plexus and Peripheral Nerve Injury, Table of Contents

J Brachial Plex Peripher Nerve Inj 2009; 04(01): e121-e126
DOI: 10.1186/1749-7221-4-14

Case report

Dahlin et al; licensee BioMed Central Ltd.

Compression of the lower trunk of the brachial plexus by a cervical rib in two adolescent girls: case reports and surgical treatment^[*]

Lars B Dahlin

¹Hand Surgery, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden

²Department of Hand Surgery, Malmö University Hospital, Malmö, Sweden

,

Clas Backman

³Department of Hand Surgery, Norrland University Hospital, Umeå, Sweden

,

Henrik Düppe

⁴Department of Orthopaedic Surgery, Malmö University Hospital, Malmö, Sweden

,

Harukazu Saito

⁵Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, Tokyo, Japan

,

Anette Chemnitz

²Department of Hand Surgery, Malmö University Hospital, Malmö, Sweden

,

Kasim Abul-Kasim

⁶Department of Radiology, Malmö University Hospital, Malmö, Sweden

,

Pavel Maly

⁶Department of Radiology, Malmö University Hospital, Malmö, Sweden

› Author Affiliations
Subject Editor:

Abstract

Presence of a cervical rib in children is extremely rare, particularly when symptoms of compression of the lower trunk of the brachial plexus occur. We present two cases with such a condition, where two young girls, 11 and 16 years of age were treated by resection of the cervical rib after a supraclavicular exploration of the lower trunk of the brachial plexus. The procedure led to successful results, objectively verified with tests in a work simulator, at one year follow-up.

Full Text

References

References
1 Cagli K, Ozcakar L, Beyazit M, Sirmali M. Thoracic outlet syndrome in an adolescent with bilateral bifid ribs. Clin Anat 2006; 19: 558-560 10.1002/ca.20280 16506236
2 Tilki HE, Stalberg E, Incesu L, Basoglu A. Bilateral neurogenic thoracic outlet syndrome. Muscle Nerve 2004; 29: 147-150 10.1002/mus.10502 14694512
3 Rayan GM. Lower trunk brachial plexus compression neuropathy due to cervical rib in young athletes. Am J Sports Med 1988; 16: 77-79 10.1177/036354658801600114 3344885
4 Urschel Jr HC, Razzuk MA. Neurovascular compression in the thoracic outlet: changing management over 50 years. Ann Surg 1998; 228: 609-617 10.1097/00000658-199810000-00017 1191545 9790350
5 Jamieson WG, Chinnick B. Thoracic outlet syndrome: fact or fancy? A review of 409 consecutive patients who underwent operation. Can J Surg 1996; 39: 321-326 8697324
6 Hug U, Jung FJ, Guggenheim M, Wedler V, Burg D, Kunzi W. [“True neurologic thoracic outlet syndrome” – anatomical features and electrophysiological long-term follow-up of lateral thenar atrophy]. Handchir Mikrochir Plast Chir 2006; 38: 42-45 10.1055/s-2006-923941 16538571
7 Ros DB. Overview of thoracic outlet syndromes. In: Machleder HI. Vascular disorders of the upper extremity. Mt Kisco; New York: 1989: 155-177
8 Balci AE, Balci TA, Cakir O, Eren S, Eren MN. Surgical treatment of thoracic outlet syndrome: effect and results of surgery. Ann Thorac Surg 2003; 75: 1091-1096 discussion 1096. 10.1016/S0003-4975(02)04725-2 12683543
9 Sanders RJ, Hammond SL. Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome. J Vasc Surg 2002; 36: 51-56 10.1067/mva.2002.123750 12096257
10 Sheth RN, Campbell JN. Surgical treatment of thoracic outlet syndrome: a randomized trial comparing two operations. J Neurosurg Spine 2005; 3: 355-363 10.3171/spi.2005.3.5.0355 16302629
11 Ide J, Kataoka Y, Yamaga M, Kitamura T, Takagi K. Compression and stretching of the brachial plexus in thoracic outlet syndrome: correlation between neuroradiographic findings and symptoms and signs produced by provocation manoeuvres. J Hand Surg Br 2003; 28: 218-223 10.1016/S0266-7681(03)00010-X 12809651
12 Ryding E, Ribbe E, Rosen I, Norgren L. A neurophysiologic investigation of thoracic outlet syndrome. Acta Chir Scand 1985; 151: 327-331 4036487
13 Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. J Vasc Surg 2007; 46: 601-604 10.1016/j.jvs.2007.04.050 17826254
14 Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurgery 2004; 55: 897-902 discussion 902-893. 10.1227/01.NEU.0000137333.04342.4D 15458598
15 Yang J, Letts M. Thoracic outlet syndrome in children. J Pediatr Orthop 1996; 16: 514-517 8784709
16 Gilliatt RW, Willison RG, Dietz V, Williams IR. Peripheral nerve conduction in patients with a cervical rib and band. Ann Neurol 1978; 4: 124-129 10.1002/ana.410040206 707983
17 Cikrit DF, Haefner R, Nichols WK, Silver D. Transaxillary or supraclavicular decompression for the thoracic outlet syndrome. A comparison of the risks and benefits. Am Surg 1989; 55: 347-352 2729770
18 Weigel G, Schmidt M, Gradl B, Girsch W. TOS-surgery via a single supraclavicular incision. Acta Neurochir Suppl 2007; 100: 141-143 17985564
19 Sunderland S. Brachial plexus lesions due to abnormal ribs: the “cervical rib” syndrome. In: Nerves and nerve injuries. Churchill Livingstone; New York: 1978: 920-942
20 Bahm J. Critical review of pathophysiologic mechanisms in thoracic outlet syndrome (TOS). Acta Neurochir Suppl 2007; 100: 137-139 17985563

Compression of the lower trunk of the brachial plexus by a cervical rib in two adolescent girls: case reports and surgical treatment[*]

Compression of the lower trunk of the brachial plexus by a cervical rib in two adolescent girls: case reports and surgical treatment^[*]