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Research Article
Hiroshi Satake
Yamagata University
Corresponding Author
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The present study included 27 consecutive patients (30 limbs) undergoing arthroscopy-assisted transaxillary first rib resection and brachial plexus neurolysis for thoracic outlet syndrome (TOS). To improve visualization, we changed the intraoperative limb position in three stages. We assessed the intraoperative parameters, including the scalene interval width between the anterior and middle interscalene muscles (interscalene base), blood loss, operation time, preoperative and postoperative QuickDASH, patient satisfaction, and complications. The mean intraoperatively measured interscalene base width was 6.2 mm. Appropriate visualization could be obtained at zero-position in the late phase. Intraoperative blood loss and operation time were significantly less in the late phase (p < 0.001). The QuickDASH score was significantly improved (42 before surgery vs. 9 at final follow-up, p < 0.001), especially in athletes relative to non-athletes (0.2 vs 14, p < 0.001). The outcome was excellent in 43.3% of cases, good in 43.3%, fair in 13.3%, and poor in none. The present approach achieved complete relief in 43% of cases overall (91% in athletes and 16% in non-athletes). Pneumothorax was present at the early phase in 3.3%. There were no other complications and no recurrences. Arthroscopic surgery is useful for TOS, especially in athletes.
Keywords
thoracic outlet syndrome (TOS), visualization, middle interscalene muscles, blood loss,operation time, preoperative and postoperative QuickDASH, patient satisfaction
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No competing interests reported.
This is a list of supplementary files associated with this preprint. Click to download.
- Video1.wmv
Video 1. Blood flow disruption demonstrated by Doppler sonography. The subclavian artery flow is disrupted when the shoulder is in abduction and external rotation (ABER).
- Video2.wmv
Video 2. Subordinate pivotal position. The deltoid, the supraspinatus and the infraspinatus are most relaxed at the subordinate pivotal position compared with the situation at 150 degrees of limb abduction or 90 degrees of limb abduction with the arm pulled upwards.
- Video3.m2ts
Video 3. Arthroscopy. Appropriate visualization can be obtained simply by inserting the arthroscope at the subordinate pivotal position/zero-position.
- Video4.wmv
Video 4. Surgical technique. Both the anterior and middle inter-scalene muscles are detached from the first rib. The first rib is excised piecemeal using a bone cutting rongeur, and neurolysis of the brachial plexus is performed.
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This preprint is under consideration at Scientific Reports. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Hiroshi Satake
Yamagata University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 17 Mar, 2021
No community comments so far
Editor assigned
On 20 Apr, 2021
Editor invited
On 12 Mar, 2021
Submission checks complete
On 12 Mar, 2021
First submitted
On 03 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
The present study included 27 consecutive patients (30 limbs) undergoing arthroscopy-assisted transaxillary first rib resection and brachial plexus neurolysis for thoracic outlet syndrome (TOS). To improve visualization, we changed the intraoperative limb position in three stages. We assessed the intraoperative parameters, including the scalene interval width between the anterior and middle interscalene muscles (interscalene base), blood loss, operation time, preoperative and postoperative QuickDASH, patient satisfaction, and complications. The mean intraoperatively measured interscalene base width was 6.2 mm. Appropriate visualization could be obtained at zero-position in the late phase. Intraoperative blood loss and operation time were significantly less in the late phase (p < 0.001). The QuickDASH score was significantly improved (42 before surgery vs. 9 at final follow-up, p < 0.001), especially in athletes relative to non-athletes (0.2 vs 14, p < 0.001). The outcome was excellent in 43.3% of cases, good in 43.3%, fair in 13.3%, and poor in none. The present approach achieved complete relief in 43% of cases overall (91% in athletes and 16% in non-athletes). Pneumothorax was present at the early phase in 3.3%. There were no other complications and no recurrences. Arthroscopic surgery is useful for TOS, especially in athletes.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
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