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Abdalla BA, Kakamad FH, Namiq HS, Asaad SK, Abdullah AS, Mustafa AM, Ghafour AK, Kareem HO, Ahmed SQM, Mohammed BA, Hasan KM, Mohammed SH. Pediatric thoracic outlet syndrome: a systematic review with metadata. Pediatr Surg Int 2024; 40:186. [PMID: 39003407 DOI: 10.1007/s00383-024-05769-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Thoracic outlet syndrome (TOS) typically considered a condition of the adult population; it is often disregarded in children and adolescents due to its limited recognition within the pediatrics. The current study aims to systematically review and provide insights into TOS among pediatric patients. METHODS PubMed, Scopus, Web of Science, and Google Scholar databases were thoroughly searched for English language studies published until March 15th, 2024. The study included those articles focusing on pediatric or adolescent individuals diagnosed with TOS. Data collected from studies encompassed date of publication, number of participants or reported cases, age (years), gender of participants, type of TOS, affected side, type of treatment, surgical approach, bony abnormality, duration of symptoms (months), outcome, and follow-up time duration (months). RESULTS The current study comprised 33 articles, 21 of which were case reports, 10 of which were case series, and the remaining were cohort studies. In this study, 356 patients were included. Females constituted 234 (65.73%) of the patient population. Among TOS types, neurogenic TOS was found among 201 (56.5%) patients. Sporting-related activity or physical activity was present in 193 (54%) patients, followed by a history of trauma in 27 (7%) patients. CONCLUSIONS Pediatric patients exhibited a higher percentage of vascular TOS than their adult counterparts, with the supraclavicular approach emerging as the preferred treatment method. Sports-related activities were identified as the primary risk factor associated with pediatric TOS.
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Affiliation(s)
- Berun A Abdalla
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq.
- Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Kurdistan, Iraq.
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq.
- Doctors City, Building 11, Apartment 50, Sulaimani, 46001, Iraq.
| | - Hiwa Shafiq Namiq
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- College of Pharmacy, Department of Basic Science, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Saywan Kakarash Asaad
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Aland S Abdullah
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Ayman M Mustafa
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Abdullah K Ghafour
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Shahid Peshraw Hospital, Chamchamal, Sulaymaniyah, Kurdistan, Iraq
| | - Honar O Kareem
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Samen Qadir Mohammed Ahmed
- Xzmat Polyclinic, Rizgari, Kalar, Sulaymaniyah, Kurdistan, Iraq
- College of Medicine, University of Garmian, Kalar, Kurdistan Region, Iraq
| | - Bilal A Mohammed
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Karzan M Hasan
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Shvan H Mohammed
- Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Kurdistan, Iraq
- Xzmat Polyclinic, Rizgari, Kalar, Sulaymaniyah, Kurdistan, Iraq
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Murthy NK, Kabre R, Corkum KS, Behbahani M, Thirunavu V, Karras CL, Alden TD. Presentation, management and outcome of surgically managed pediatric thoracic outlet syndrome. Childs Nerv Syst 2022; 38:1949-1954. [PMID: 35970943 DOI: 10.1007/s00381-022-05592-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Thoracic outlet syndrome (TOS) is a rare disorder involving compression of the brachial plexus, subclavian artery, and subclavian vein. There is a paucity of data for this pathology's surgical treatment within pediatrics. The objective of this study is to explore the presentation, management, and outcome of pediatric TOS. METHODS A retrospective chart review was conducted for 44 patients at a single institution undergoing surgery for TOS. Data was collected on demographics, pre- and postoperative factors, and outcomes. RESULTS Forty-four patients underwent 50 surgeries (8 bilaterally). The average age was 15.5 years with 72% female. The most common symptoms were numbness (72%) and pain (66%), with a normal exam in 58%. The average symptom duration prior to surgery was 35.2 months. A supraclavicular approach was performed in all patients, with anterior scalene section (90%), rib resection (72%), neurolysis (92%), and intraoperative EMG (84%) commonly used. Two patients had a lymphatic leak. All patients reported subjective improvement of preoperative symptoms of numbness (26%), pain (22%), and weakness (6%). Differences between vTOS (n = 9) and nTOS (n = 35) included higher preop swelling (p < 0.012), decreased symptom duration (p < 0.022), higher venogram usage (p < 0.0030), and higher preoperative thrombolytics/angioplasty (p < 0.001) in vTOS compared to nTOS. A comparison of soft tissue and soft tissue with bone decompression did not reveal any outcome differences. CONCLUSION Pediatric TOS benefits from a multidisciplinary approach, showing good outcomes in postoperative symptom resolution. In our cohort, a supraclavicular approach provided an effective window for decompression with a low complication rate.
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Affiliation(s)
- Nikhil K Murthy
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, USA
| | - Rashmi Kabre
- Department of Surgery, Northwestern University, Chicago, IL, USA
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kristine S Corkum
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mandana Behbahani
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, USA
| | - Vineeth Thirunavu
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, USA
| | - Constantine L Karras
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, USA
| | - Tord D Alden
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA.
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, USA.
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Abstract
Venous thoracic outlet syndrome represents a relatively rare but important diagnosis in the adolescent population with increasing recognition. Compression of the subclavian vein within the costoclavicular space can lead to episodic venous outlet obstruction in the upper extremity, with edema, rubor and functional symptoms. Over time, cumulative injury and compression can lead to thrombosis of the vein, referred to as "effort thrombosis" or the Paget-Schroetter syndrome. This progression can lead to the need for acute management of the venous thromboembolism, requirement for thoracic outlet decompression surgery and the potential for long-term sequelae such as post-thrombotic syndrome. Management is focused on clot minimization, anticoagulation during the period of endothelial injury and inflammation and surgical decompression via first rib resection, anterior scalenectomy and venolysis to remove external compression of the vein. This manuscript reviews the diagnosis, evaluation and treatment of venous thoracic outlet syndrome and Paget-Schroetter syndrome.
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Affiliation(s)
- Biren P Modi
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3, Boston, MA 02115, USA.
| | - Rush Chewning
- Division of Interventional Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Riten Kumar
- Division of Hematology and Oncology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Codd CM, Abzug JM. Upper Extremity Compressive Neuropathies in the Pediatric and Adolescent Populations. Curr Rev Musculoskelet Med 2020; 13:696-707. [PMID: 32720100 PMCID: PMC7661676 DOI: 10.1007/s12178-020-09666-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Although somewhat rare, upper extremity compressive neuropathies can occur in the pediatric and adolescent populations due to various etiologies. Some of the most common conditions seen include thoracic outlet syndrome, supracondylar process syndrome, cubital tunnel syndrome with subluxation of the ulnar nerve, and carpal tunnel syndrome. This review will focus on these diagnoses and how to address them in the pediatric and adolescent populations. RECENT FINDINGS Due to the rarity of upper extremity compressive neuropathies in the pediatric and adolescent populations, substantial advancement in the literature does not routinely occur. However, recent literature has found a difference in the rate of various subtypes of thoracic outlet syndrome in children versus adults. Additionally, cubital tunnel syndrome associated with ulnar nerve subluxation/instability has recently been found to have better outcomes following surgical decompression of the ulnar nerve and transposition than those with stable ulnar nerves. In summary, this review provides the most recent knowledge surrounding upper extremity compressive and entrapment neuropathies in the pediatric and adolescent populations.
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Affiliation(s)
- Casey M. Codd
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD USA
| | - Joshua M. Abzug
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD USA
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Partiot C, Guillon M, Peressinotto D, Castex D, Maureille B. Cervical ribs in human early life: morphological variability and first identification as a morbidity criterion in a past population. J Anat 2020; 237:119-132. [PMID: 32187701 DOI: 10.1111/joa.13178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/16/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022] Open
Abstract
Despite the medical literature on supernumerary cervical ribs in extant adult samples, little is known about their development and occurrence in early infancy. The documentation of cervical ribs in modern samples of fetuses and neonates is indeed affected by ethical as well as technical limitations. The aim of the present study was to investigate their frequencies and morphological variability in the first known archaeological collection of very young children with this anatomical variant. The study sample comes from the 8B-51 necropolis on the Saï island (Sudan) and dates to the Classic Kerma Period (XVIIIe-XVIe centuries BC). It consists of 64 individuals deceased between 24 weeks of amenorrhoea and 2 years of age. Bilateral or unilateral cervical ribs were found in 27 individuals. A total of 43 cervical ribs were identified, 38 of which are fully preserved. According to these observations, at least 42% of the individuals have unilateral or bilateral cervical ribs, with an average maximum length of < 1 cm. This frequency is very high compared to those observed in contemporary adult samples (up to 3%). First, the comparison of our results with biological and genetic research demonstrating the link between the occurrence of cervical ribs and a reduced chance of survival during infancy allows the first identification of this trait as an indicator of morbidity in an archaeological collection, a morbidity to which a genetic homogeneity or even endogamy could contribute. Second, the number of ribs studied makes it possible to propose a morphological classification based on the general shape and the shape of the articular facets, classification that can be used tos refine the analyses of the trait in future samples.
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Affiliation(s)
- Caroline Partiot
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
| | - Mark Guillon
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France.,Inrap, Boulevard de Verdun, Le Grand Quevilly, France
| | - David Peressinotto
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France.,Hades Archéologie, Balma, France
| | - Dominique Castex
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
| | - Bruno Maureille
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
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Kumar R, Harsh K, Saini S, O’Brien SH, Stanek J, Warren P, Giver J, Go MR, Kerlin BA. Treatment-Related Outcomes in Paget-Schroetter Syndrome-A Cross-Sectional Investigation. J Pediatr 2019; 207:226-232.e1. [PMID: 30528572 PMCID: PMC6556226 DOI: 10.1016/j.jpeds.2018.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/03/2018] [Accepted: 11/06/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate treatment-related outcomes, namely radiological clot resolution, post-thrombotic syndrome (PTS), and health related quality-of-life (HRQoL) scores, in children with Paget-Schroetter syndrome (PSS) undergoing multidisciplinary management, including anticoagulation and decompressive rib-resection surgery, with or without thrombolytic therapy. STUDY DESIGN We identified all patients treated for PSS at our institution between the years 2010 and 2017. Baseline clinical and radiologic data were abstracted from medical records. Two validated survey instruments to quantify PTS and HRQoL were mailed to eligible patients. Standard statistical methods were used to summarize these measures. RESULTS In total, 22 eligible patients were identified; 10 were treated with thrombolysis followed by anticoagulation and rib resection, and 12 were treated with anticoagulation and rib resection alone. Nineteen patients responded to the survey instruments. Median age at deep vein thrombosis diagnosis and survey completion were 16.3 and 20.4 years, respectively. Nineteen of 22 patients had thrombus resolution on radiologic follow-up. Fourteen of 19 survey respondents reported signs/symptoms of PTS of which the majority (12/14) reported mild PTS. Aggregate total, physical, and psychosocial HRQoL scores reported were 90.6, 96.7, and 93.3, respectively. Thrombolytic therapy was not associated with a significant improvement in radiologic, clinical or HRQoL outcomes. CONCLUSIONS Most patients with PSS had complete thrombus resolution on imaging. Only 11% of survey respondents reported moderate PTS. The entire cohort reported excellent HRQoL scores. The role for thrombolytic therapy in the management of childhood PSS remains incompletely elucidated.
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Affiliation(s)
- Riten Kumar
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University, Columbus, OH.
| | - Katherine Harsh
- College of Medicine, The Ohio State University, Columbus, OH
| | - Surbhi Saini
- Division of Pediatric Hematology/Oncology, Hershey Children’s Hospital, Penn State University, Hershey, PA,Department of Pediatrics, Penn State University, Hershey, PA
| | - Sarah H. O’Brien
- Division of Pediatric Hematology/Oncology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH,Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Joseph Stanek
- Division of Pediatric Hematology/Oncology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH
| | - Patrick Warren
- Department of Pediatrics, The Ohio State University, Columbus, OH,Division of Interventional Radiology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH
| | - Jean Giver
- Division of Pediatric Hematology/Oncology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH
| | - Michael R. Go
- Department of Vascular Diseases and Surgery, The Ohio State University, Columbus, OH
| | - Bryce A. Kerlin
- Division of Pediatric Hematology/Oncology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH,Department of Pediatrics, The Ohio State University, Columbus, OH
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Matos JM, Gonzalez L, Kfoury E, Echeverria A, Bechara CF, Lin PH. Outcomes following operative management of thoracic outlet syndrome in the pediatric patients. Vascular 2018; 26:410-417. [DOI: 10.1177/1708538117747628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives Thoracic outlet syndrome, a condition commonly reported in adults, occurs infrequently in the pediatric population. The objective of this study was to assess the outcome of surgical interventions of thoracic outlet syndrome in pediatric patients. Methods Clinical records of all pediatric patients with thoracic outlet syndrome who underwent operative repair from 2002 to 2015 in a tertiary pediatric hospital were reviewed. Pertinent clinical variables and treatment outcomes were analyzed. Results Sixty-eight patients underwent a total of 72 thoracic outlet syndrome operations (mean age 15.7 years). Venous, neurogenic, and arterial thoracic outlet syndromes occurred in 39 (57%), 21 (31%), and 8 (12%) patients, respectively. Common risk factors for children with venous thoracic outlet syndrome included sports-related injuries (40%) and hypercoagulable disorders (33%). Thirty-five patients (90%) with venous thoracic outlet syndrome underwent catheter-based interventions followed by surgical decompression. All patients underwent first rib resection with scalenectomy via either a supraclavicular approach (n = 60, 88%) or combined supraclavicular and infraclavicular incisions (n = 8, 12%). Concomitant temporary arteriovenous fistula creation was performed in 14 patients (36%). Three patients with arterial thoracic outlet syndrome underwent first rib resection with concomitant subclavian artery aneurysm repair. The mean follow-up duration was 38.4 ± 11.6 months. Long-term symptomatic relief was achieved in 94% of patients. Conclusions Venous thoracic outlet syndrome is the most common form of thoracic outlet syndrome in children, followed by neurogenic and arterial thoracic outlet syndromes. Competitive sports-related injuries remain the most common risk factor for venous and neurogenic thoracic outlet syndromes. Temporary arteriovenous fistula creation was useful in venous thoracic outlet syndrome patients in selective children. Surgical decompression provides durable treatment success in children with all subtypes of thoracic outlet syndrome.
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Affiliation(s)
- Jesus M Matos
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houstan, TX, USA
| | - Lorena Gonzalez
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houstan, TX, USA
| | - Elias Kfoury
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houstan, TX, USA
| | - Angela Echeverria
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houstan, TX, USA
| | - Carlos F Bechara
- Department of Cardiothoracic and Vascular Surgery, Houston Methodist Hospital, Houstan, TX, USA
| | - Peter H Lin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houstan, TX, USA
- University Vascular Associates, Los Angeles, CA, USA
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A case of symmetric retrograde thromboembolic cerebral infarction in an 8-year-old child due to arterial thoracic outlet syndrome. Childs Nerv Syst 2018; 34:2503-2507. [PMID: 30019112 PMCID: PMC6224015 DOI: 10.1007/s00381-018-3911-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/09/2018] [Indexed: 12/27/2022]
Abstract
Arterial type of thoracic outlet syndrome belongs to the most unusual mechanisms of stroke in children in the first decade of life. We present a case diagnosed for bilateral and symmetric changes due to retrograde thromboembolic phenomenon. Regarding the age of the patient, the appropriate diagnostics and management are still a matter of debate in pediatric and neurological literature.
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Hong J, Pisapia JM, Ali ZS, Heuer AJ, Alexander E, Heuer GG, Zager EL. Long-term outcomes after surgical treatment of pediatric neurogenic thoracic outlet syndrome. J Neurosurg Pediatr 2018; 21:54-64. [PMID: 29125442 DOI: 10.3171/2017.7.peds17257] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurogenic thoracic outlet syndrome (nTOS) is an uncommon compression syndrome of the brachial plexus that presents with pain, sensory changes, and motor weakness in the affected limb. The authors reviewed the clinical presentations and outcomes in their series of pediatric patients with surgically treated nTOS over a 6-year period. METHODS Cases of nTOS in patients age 18 years or younger were extracted for analysis from a prospective database of peripheral nerve operations. Baseline patient characteristics, imaging and neurophysiological data, operative findings, and outcomes and complications were assessed. RESULTS Twelve patients with 14 cases of nTOS surgically treated between April 2010 and December 2016 were identified. One-third of the patients were male, and 2 male patients underwent staged, bilateral procedures. Disabling pain (both local and radiating) was the most common presenting symptom (100%), followed by numbness (35.7%), then tingling (28.6%). The mean duration of symptoms prior to surgery was 15.8 ± 6.6 months (mean ± SD). Sports-related onset of symptoms was seen in 78.6% of cases. Imaging revealed cervical ribs in 4 cases, prominent C-7 transverse processes in 4 cases, abnormal first thoracic ribs in 2 cases, and absence of bony anomalies in 4 cases. Neurophysiological testing results were normal in 85.7% of cases. Conservative management failed in all patients, with 5 patients reporting minimal improvement in symptoms with physical therapy. With a mean follow-up after surgery of 22 ± 18.3 months (mean ± SD), pain relief was excellent (> 90%) in 8 cases (57.1%), and good (improved > 50%) in 6 cases (42.9%). On univariate analysis, patients who reported excellent pain resolution following surgery at long-term follow-up were found to be significantly younger, and to have suffered a shorter duration of preoperative symptoms than patients who had worse outcomes. Lack of significant trauma or previous surgery to the affected arm was also associated with excellent outcomes. There were 4 minor complications in 3 patients within 30 days of surgery: 1 patient developed a small pneumothorax that resolved spontaneously; 1 patient suffered a transient increase in pain requiring consultation, followed by hiccups for a period of 3 hours that resolved spontaneously; and 1 patient fell at home, with transient increased pain in the surgically treated extremity. There were no new neurological deficits, wound infections, deep vein thromboses, or readmissions. CONCLUSION Pediatric nTOS commonly presents with disabling pain and is more frequently associated with bony anomalies compared with adult nTOS. In carefully selected patients, surgical decompression of the brachial plexus results in excellent pain relief, which is more likely to be seen in younger patients who present for early surgical evaluation.
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Affiliation(s)
- Jennifer Hong
- 1Divison of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jared M Pisapia
- 2Department of Neurosurgery, University of Pennsylvania, Philadelphia; and
| | - Zarina S Ali
- 2Department of Neurosurgery, University of Pennsylvania, Philadelphia; and
| | - Austin J Heuer
- 3Division of Neurosurgery, The Children's Hospital of Philadelphia, Pennsylvania
| | - Erin Alexander
- 3Division of Neurosurgery, The Children's Hospital of Philadelphia, Pennsylvania
| | - Gregory G Heuer
- 2Department of Neurosurgery, University of Pennsylvania, Philadelphia; and.,3Division of Neurosurgery, The Children's Hospital of Philadelphia, Pennsylvania
| | - Eric L Zager
- 2Department of Neurosurgery, University of Pennsylvania, Philadelphia; and
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Henry BM, Vikse J, Sanna B, Taterra D, Gomulska M, Pękala PA, Tubbs RS, Tomaszewski KA. Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations. World Neurosurg 2017; 110:e965-e978. [PMID: 29203316 DOI: 10.1016/j.wneu.2017.11.148] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/23/2017] [Accepted: 11/25/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cervical ribs (CR) are supernumerary ribs that arise from the seventh cervical vertebra. In the presence of CR, the boundaries of the interscalene triangle can be further constricted and result in neurovascular compression and thoracic outlet syndrome (TOS). The aim of our study was to provide a comprehensive evidence-based assessment of CR prevalence and their association with TOS as well as surgical approach to excision of CR and surgical patients' characteristics. METHODS A thorough search of major electronic databases was conducted to identify any relevant studies. Data on the prevalence, laterality, and side of CR were extracted from the eligible studies for both healthy individuals and patients with TOS. Data on the type of TOS and surgical approach to excision of CR were extracted as well. RESULTS A total of 141 studies (n = 77,924 participants) were included into the meta-analysis. CR was significantly more prevalent in patients with TOS than in healthy individuals, with pooled prevalence estimates of 29.5% and 1.1%, respectively. More than half of the patients had unilateral CR in both the healthy and the TOS group. The analysis showed that 51.3% of the symptomatic patients with CR had vascular TOS, and 48.7% had neurogenic TOS. Most CR were surgically excised in women using a supraclavicular approach. CONCLUSIONS CR ribs are frequent findings in patients with TOS. We recommended counseling asymptomatic patients with incidentally discovered CR on the symptoms of TOS, so that if symptoms develop, the patients can undergo prompt and appropriate workup and treatment.
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Affiliation(s)
- Brandon Michael Henry
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland.
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Surgery, University of Cagliari, Monserrato, Italy
| | - Dominik Taterra
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Martyna Gomulska
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław A Pękala
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
| | - Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
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Cox M, Epelman M, Chandra T, Meyers AB, Johnson CM, Podberesky DJ. Non–Catheter-related Venous Thromboembolism in Children: Imaging Review from Head to Toe. Radiographics 2017; 37:1753-1774. [DOI: 10.1148/rg.2017170036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Mougnyan Cox
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Monica Epelman
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Tushar Chandra
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Arthur B. Meyers
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Craig M. Johnson
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Daniel J. Podberesky
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
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12
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Janák D, Novotný K, Roček M, Rohn V. Thoracic Outlet Syndrome: A Significant Family Genetic Phenotypic Presentation. Prague Med Rep 2017; 117:117-123. [PMID: 27668528 DOI: 10.14712/23362936.2016.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We report on a very rare case of diagnosis and successful surgical treatment of three young family members with a four-fold presentation of thoracic outlet syndrome. In the relevant family case, we are considering and discussing the population incidence, a possible HOX genes disorder, and a significant phenotypic presentation.
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Affiliation(s)
- David Janák
- Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. .,Institute of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Karel Novotný
- Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Miloslav Roček
- Department of Radiology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Vilém Rohn
- Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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13
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Betensky M, Bittles MA, Colombani P, Goldenberg NA. How We Manage Pediatric Deep Venous Thrombosis. Semin Intervent Radiol 2017; 34:35-49. [PMID: 28265128 PMCID: PMC5334487 DOI: 10.1055/s-0036-1597762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Over the past two decades, the incidence and recognition of venous thromboembolism (VTE) in children has significantly increased, likely as a result of improvements in the medical care of critically ill patients and increased awareness of thrombotic complications among medical providers. Current recommendations for the management of VTE in children are largely based on data from pediatric registries and observational studies, or extrapolated from adult data. The scarcity of high-quality evidence-based recommendations has resulted in marked variations in the management of pediatric VTE among providers. The purpose of this article is to summarize our institutional approach for the management of VTE in children based on available evidence, guidelines, and clinical practice considerations. Therapeutic strategies reviewed in this article include the use of conventional anticoagulants, parenteral targeted anticoagulants, new direct oral anticoagulants, thrombolysis, and mechanical approaches for the management of pediatric VTE.
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Affiliation(s)
- Marisol Betensky
- Pediatric Thrombosis Program, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
- Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark A. Bittles
- Department of Radiology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Paul Colombani
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Neil A. Goldenberg
- Pediatric Thrombosis Program, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
- Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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14
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Paget-Schroetter syndrome in 21 children: outcomes after multidisciplinary care. J Pediatr 2015; 166:1493-7.e1. [PMID: 25882874 DOI: 10.1016/j.jpeds.2015.03.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 02/19/2015] [Accepted: 03/11/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To review the presentation, management, and outcomes of Paget-Schroetter syndrome (PSS) in children and propose a multidisciplinary treatment algorithm involving pediatric and vascular surgery, interventional radiology, and hematology. STUDY DESIGN Patients with PSS presenting between 2003 and 2013 were reviewed. Demographics, symptoms, therapies, and functional outcomes were noted. Data from early patients informed the development of a multidisciplinary treatment algorithm applied to later patients. RESULTS Of 21 patients, mean ± SD age was 16 ± 1.6 years and 11 (52%) were male. Of patients with complete presentation data, common symptoms were edema (84%), discoloration (58%), and pain (58%). Thrombophilia workup revealed one heterozygote for factor V Leiden, 2 patients with factor VIII elevation and 1 patient with mildly low antithrombin. The most recent 8 patients were treated according to an algorithm developed by a multidisciplinary working group through experience with the first 13 cases. All patients underwent a venogram, endovascular intervention (including 15 receiving catheter-directed thrombolysis), and operative ipsilateral thoracic outlet decompression (first rib resection, anterior scalenectomy, and venolysis). Postoperative complications included hemothorax (2), pneumothorax (1), and recurrent thrombosis (2). Follow up duration was 12 ± 9.5 months. Symptoms recurred transiently in 1 patient. CONCLUSION Pediatric patients with PSS can be treated successfully using a multidisciplinary treatment algorithm including anticoagulation, catheter-directed thrombolysis, and operative decompression of the thoracic outlet. Early outcomes are promising.
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15
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Bilateral cervical ribs in a Dobermann Pinscher. Vet Comp Orthop Traumatol 2015; 28:145-50. [PMID: 25650786 DOI: 10.3415/vcot-14-07-0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/12/2014] [Indexed: 11/17/2022]
Abstract
An 11-year-old intact female Doberman Pinscher was presented with the complaint of non-ambulatory tetraparesis. Clinical and neurological examination revealed a caudal cervical spinal cord disfunction (C6-T2 spinal cord segments). Magnetic resonance imaging and computed tomographic (CT) findings of the cervical spine were consistent with caudal cervical spondylomyelopathy (CSM). During the diagnostic work-up for the cervical spine, bilateral bone anomalies involving the seventh cervical vertebra and the first ribs were found on radiographs and CT examination. The rib anomalies found in this dog appear similar to cervical ribs widely described in human medicine. In people, cervical ribs are associated with a high rate of stillbirth, early childhood cancer, and can cause the thoracic outlet syndrome, characterized by neurovascular compression at level of superior aperture of the chest. In dogs, only some sporadic anatomopathological descriptions of cervical ribs exist. In this report the radiographic and CT findings of these particular vertebral and rib anomalies along with their relationships with adjacent vasculature and musculature are shown intravitam in a dog. Specific radiographic and CT findings described in this report may help in reaching a presumptive diagnosis of this anomaly. Finally, their clinical and evolutionary significance are discussed.
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16
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Vu AT, Patel PA, Elhadi H, Schwentker AR, Yakuboff KP. Thoracic outlet syndrome in the pediatric population: case series. J Hand Surg Am 2014; 39:484-487.e2. [PMID: 24495625 DOI: 10.1016/j.jhsa.2013.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/14/2013] [Accepted: 11/14/2013] [Indexed: 02/02/2023]
Abstract
We present 4 patients, 4 months to 10 years of age, with thoracic outlet syndrome. All were referred to the brachial plexus clinic. Three patients were diagnosed with vascular thoracic outlet syndrome after clinical evaluation and diagnostic imaging. Three had a cervical rib and 1 had an anomalous first rib. All patients were treated surgically through a supraclavicular approach and had resolution of the symptoms. No postoperative complications were noted.
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Affiliation(s)
- Anthony T Vu
- Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati, Cincinnati, OH; Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Plastic Surgery, Institute of Reconstructive Surgery, New York University, New York, NY
| | - Parit A Patel
- Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati, Cincinnati, OH; Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Plastic Surgery, Institute of Reconstructive Surgery, New York University, New York, NY
| | - Haithem Elhadi
- Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati, Cincinnati, OH; Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Plastic Surgery, Institute of Reconstructive Surgery, New York University, New York, NY
| | - Ann R Schwentker
- Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati, Cincinnati, OH; Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Plastic Surgery, Institute of Reconstructive Surgery, New York University, New York, NY
| | - Kevin P Yakuboff
- Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati, Cincinnati, OH; Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Plastic Surgery, Institute of Reconstructive Surgery, New York University, New York, NY.
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17
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Chan KH, Gitomer SA, Perkins JN, Liang C, Strain JD. Clinical presentation of cervical ribs in the pediatric population. J Pediatr 2013; 162:635-6. [PMID: 23219244 DOI: 10.1016/j.jpeds.2012.10.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/24/2012] [Accepted: 10/23/2012] [Indexed: 10/27/2022]
Abstract
Cervical ribs may cause thoracic outlet syndrome in adults, but symptoms are poorly described in children. In our series, 88.8% of the 322 children were asymptomatic. The most common symptoms were neck mass and pain. Useful diagnostic tools were cervical spine and chest radiographs. Differential diagnosis of a supraclavicular mass includes cervical ribs.
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Affiliation(s)
- Kenny H Chan
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO 80045, USA.
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18
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Lebhar J, Marleix S, Fraisse B, Chapuis M, Bruneau B, Violas P. [Thoracic outlet syndrome in a child: a rare pediatric diagnosis]. Arch Pediatr 2012; 20:30-2. [PMID: 23266168 DOI: 10.1016/j.arcped.2012.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 08/14/2012] [Accepted: 10/15/2012] [Indexed: 11/29/2022]
Abstract
Thoracic outlet syndrome (TOS) is a rare pediatric syndrome and few cases have been reported in the literature. The authors report the case of a 10-year-old boy with generalized arm pain and neck stiffness. The angiocomputed tomography revealed the presence of a TOS caused by an additional cervical rib and stenosis of the sub-clavian artery. The resection of this rib relieved the patient of his pain during a full year following surgery. This case reminds us that children can also be affected by TOS. When a cervical rib causes TOS, a resection is often necessary.
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Affiliation(s)
- J Lebhar
- Service de chirurgie pédiatrique, hôpital Sud, boulevard de Bulgarie, Rennes, France.
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Caputo FJ, Wittenberg AM, Vemuri C, Driskill MR, Earley JA, Rastogi R, Emery VB, Thompson RW. Supraclavicular decompression for neurogenic thoracic outlet syndrome in adolescent and adult populations. J Vasc Surg 2012; 57:149-57. [PMID: 23127984 DOI: 10.1016/j.jvs.2012.07.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 07/12/2012] [Accepted: 07/16/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was conducted to better define clinical results and understand factors determining responsiveness to surgical treatment for neurogenic thoracic outlet syndrome (NTOS) in adolescent and adult populations. METHODS A retrospective review was conducted for 189 patients with disabling NTOS who underwent primary supraclavicular decompression (scalenectomy, brachial plexus neurolysis and first rib resection, with or without pectoralis minor tenotomy) from April 2008 to December 2010. Clinical characteristics were compared between 35 adolescent patients (aged<21 years) and 154 adults (aged>21 years). Functional outcome measures were assessed before surgery and at 3- and 6-month follow-up using a composite NTOS Index combining the Disabilities of the Arm, Shoulder and Hand (DASH) survey, the Cervical-Brachial Symptom Questionnaire (CBSQ), and a 10-point visual analog scale (VAS) for pain. RESULTS Adolescent and adult patients were not significantly different with respect to sex (overall 72.5% female), side affected (58.7% right, 60.3% dominant limb), bony anomalies (23.3%), previous injury (55.6%), coexisting pain disorders (11.1%), and positive responses to scalene muscle anesthetic blocks (95.6%). Compared with adults, adolescent patients had a significantly (P<.05) lower incidence of depression (11.4% vs 41.6%), motor vehicle injury (5.7% vs 20.1%), previous operations (11.4% vs 29.9%), preoperative use of opiate medications (17.1% vs 44.8%), and symptom duration>2 years (24.2% vs 50.0%). Mean preoperative NTOS Index (scale 0-100) was significantly lower in adolescent vs adult patients (46.5±3.6 vs 58.5±1.7; P=.009), and hospital length of stay was 4.4±0.2 vs 4.9±0.1 days (P=.03), but the rate of postoperative complications was no different (overall, 4.2%). Although both groups exhibited significant improvement in functional outcome measures at 3 and 6 months, adolescent patients had significantly lower NTOS Index (10.4±3.1 vs 39.3±3.3; P<.001) and use of opiate medications (11.4% vs 47.4%; P<.001) compared with adults. CONCLUSIONS Adolescents undergoing supraclavicular decompression for NTOS had more favorable preoperative characteristics and enhanced 3-month and 6-month functional outcomes than adults. Further study is needed to delineate the age-dependent and independent factors that promote optimal surgical outcomes for NTOS.
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Affiliation(s)
- Francis J Caputo
- Center for Thoracic Outlet Syndrome, Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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20
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Schroeder S, Cannizzaro E, Kellenberger CJ, Saurenmann RK. A 12-year-old girl with absent radial pulse: arterial thoracic outlet syndrome with subclavian artery aneurysm and thrombosis of the brachial artery. Eur J Pediatr 2012; 171:1707-9. [PMID: 22543529 DOI: 10.1007/s00431-012-1748-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 04/12/2012] [Indexed: 11/30/2022]
Abstract
Brachial arterial occlusion is rare in children and adolescents. Once a traumatic cause is excluded, the differential diagnosis consists of a variety of rare conditions. We report the case of a 12-year-old girl whose presenting symptoms--an absent radial pulse and Raynaud's phenomenon of the right hand--could be easily mistaken for a vasculitis. She was found to have arterial thoracic outlet syndrome with right subclavian artery compression and aneurysm formation caused by an anomalous first rib and consecutive thromboembolic occlusion of the brachial artery. The diagnosis and differential diagnosis of this condition are reviewed.
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Affiliation(s)
- S Schroeder
- Rheumatology, University Children's Hospital, Steinwiesstr. 75, 8032 Zurich, Switzerland.
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21
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Tubbs RS, Muhleman M, Miller J, Shoja MM, Loukas M, Wellons JC, Oakes WJ. Cervical ribs with neurological sequelae in children: a case series. Childs Nerv Syst 2012; 28:605-8. [PMID: 22006364 DOI: 10.1007/s00381-011-1608-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 09/28/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cervical ribs may result in thoracic outlet syndrome. Neurological compromise in children with cervical ribs, however, is rare. PATIENTS AND METHODS We report our experience with cervical ribs in a pediatric population and review this specific literature. RESULTS In our experience with a pediatric neurosurgical population, symptomatic cervical ribs were often identified in patients with Chiari I malformation. Surgical resection of symptomatic cervical ribs in children appears to have good long-term results. CONCLUSIONS Based on our experience, symptomatic cervical ribs should not be considered pathology peculiar to the adult population. Although uncommon, children may present with symptomatic cervical ribs that may necessitate surgical intervention.
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Affiliation(s)
- R Shane Tubbs
- Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, AL 35233, USA.
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22
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Teddy P, Johnson R, Cai R, Wallace D. Surgery for paediatric thoracic outlet syndrome. J Clin Neurosci 2012; 19:235-40. [DOI: 10.1016/j.jocn.2011.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 05/25/2011] [Indexed: 10/15/2022]
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23
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Les thromboses veineuses profondes des membres supérieurs. Rev Med Interne 2011; 32:567-74. [DOI: 10.1016/j.revmed.2010.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 05/03/2010] [Accepted: 08/16/2010] [Indexed: 11/18/2022]
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Fodor M, Fodor L, Ciuce C. Anomalies of thoracic outlet in human fetuses: anatomical study. Ann Vasc Surg 2011; 25:961-8. [PMID: 21831584 DOI: 10.1016/j.avsg.2011.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/26/2011] [Accepted: 05/15/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thoracic outlet syndrome (TOS) identifies the clinical condition determined by the mechanical compression and entrapment of the subclavian vessels and the brachial plexus cords within the space delineated by the scalene muscles, the clavicle, and the first rib. To date, there are no concluding explanations concerning the real causes of the appearance of TOS in children. This is the first study to investigate the existence, frequency, and type of thoracic outlet anomalies in the prenatal stage (human fetuses). METHODS Eighty cervical dissections (40 consecutive spontaneously aborted human fetuses) were performed, and the musculoskeletal, vascular, and nervous elements that pass through the thoraco-cervico-axillary region were investigated. RESULTS Overall, anatomical anomalies of the thoraco-cervico-axillary region were found in 60% of the 80 cervical dissections. Nine (22.5%) of the 40 fetuses had normal bilateral anatomy. In 6.3%, the scalene hiatus had an oval shape due to the common costal insertion of the anterior and middle scalene muscles. Fibromuscular bands were found in 15% of the fetuses. Hypertrophy of the anterior scalene muscle was seen in 12.5% of the dissections. In 28.7% of the cervical dissections, hypertrophy of the C7 transversal process was noted, bilateral in seven cases. There was one case of a "C-shaped" clavicle anomaly. The absence of the internal mammary artery was noted in one case. CONCLUSION This study shows that the presence of TOS anomalies in fetuses is not a rare occurrence, emphasizing a pathological cervical background which can be harmful in situations of cervical trauma or inflammatory processes. Having knowledge of the types of anomalies which can lead to TOS is important for performing a complete surgical correction and avoiding the high failure rate of recurrent TOS.
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Affiliation(s)
- Marius Fodor
- Vascular Surgery Unit, First Surgical Clinic, Emergency District Hospital, University of Medicine and Pharmacy, Cluj Napoca, Romania.
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25
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Hooper TL, Denton J, McGalliard MK, Brismée JM, Sizer PS. Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis. J Man Manip Ther 2011; 18:74-83. [PMID: 21655389 DOI: 10.1179/106698110x12640740712734] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Thoracic outlet syndrome (TOS) is a frequently overlooked peripheral nerve compression or tension event that creates difficulties for the clinician regarding diagnosis and management. Investigators have categorized this condition as vascular versus neurogenic, where vascular TOS can be subcategorized as either arterial or venous and neurogenic TOS can subcategorized as either true or disputed. The thoracic outlet anatomical container presents with several key regional components, each capable of compromising the neurovascular structures coursing within. Bony and soft tissue abnormalities, along with mechanical dysfunctions, may contribute to neurovascular compromise. Diagnosing TOS can be challenging because the symptoms vary greatly amongst patients with the disorder, thus lending to other conditions including a double crush syndrome. A careful history and thorough clinical examination are the most important components in establishing the diagnosis of TOS. Specific clinical tests, whose accuracy has been documented, can be used to support a clinical diagnosis, especially when a cluster of positive tests are witnessed.
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Affiliation(s)
- Troy L Hooper
- Center for Rehabilitation Research, School of Allied Health Sciences, Texas Tech University Health Science Center
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26
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Sabapathy SR, Venkatramani H, Bhardwaj P. Pseudarthrosis of cervical rib: an unusual cause of thoracic outlet syndrome. J Hand Surg Am 2010; 35:2018-21. [PMID: 21074954 DOI: 10.1016/j.jhsa.2010.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 08/11/2010] [Accepted: 08/16/2010] [Indexed: 02/02/2023]
Abstract
Thoracic outlet syndrome is uncommon in adolescence. Cervical rib fracture is an extremely rare cause of thoracic outlet syndrome in this age group. We report an unusual case of thoracic outlet syndrome in a 14-year-old girl caused by pseudarthrosis of the cervical rib. A magnetic resonance imaging scan showed significant compression of the brachial plexus by the pseudarthrosis mass. Excision of the cervical rib through a supraclavicular approach gave excellent results in this case.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, India.
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Maru S, Dosluoglu H, Dryjski M, Cherr G, Curl GR, Harris LM. Thoracic outlet syndrome in children and young adults. Eur J Vasc Endovasc Surg 2009; 38:560-4. [PMID: 19703780 DOI: 10.1016/j.ejvs.2009.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 06/20/2009] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Thoracic outlet syndrome has been well described in the population between 25 and 40 years of age, and is less frequently reported in those in the first two decades of life. The objective of this study was to review results with onset of TOS in the first two decades of life to determine type of presentation and outcomes from surgical intervention. METHODS AND MATERIALS Charts of all patients in the first two decades of life, operated on for TOS between 1994 and 2006 were reviewed with follow-up by clinic visit and phone survey to assess the patients' current level of activity and relief from symptoms. RESULTS Twelve patients were identified (13 operations), with a mean age of 16.8 years. Acute ischemic symptoms were the initial presentation for 38%, venous TOS in 24%, and neurogenic symptoms in 38%. All patients had symptom relief with surgery with a mean time to resolution of 10.9 weeks. All patients remained symptom free or improved at follow-up. CONCLUSIONS Vascular TOS is much more common in TOS presenting in the first two decades of life. Surgical intervention for TOS in this population results in long-lasting symptom relief and should be considered for all subtypes of patients.
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Affiliation(s)
- S Maru
- State University of New York at Buffalo, Department of Surgery, Buffalo, NY, USA
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