Le Syndrome du Défilé Thoracique — L’algorithme du traitement

Abstract

The symptoms of Thoracic Outlet Syndrome (TOS) are due to the compression of the brachial plexus or the subclavian vessels. It causes pain, a sensation of heaviness, and paresthesias in the corresponding upper limb. The syndrome can have neurological, vascular, or mixed etiology. The aim of this study is to evaluate patients who underwent surgical decompression of the brachial plexus via a supraclavicular approach and detachment of the pectoralis minor tendon from the coracoid process.

From 2020 to 2023, a retrospective analysis was conducted on 12 patients (3 men and 9 women) with an average age of 35 years (range 25–55) with TOS of neurological or mixed etiology. They underwent surgical supraclavicular decompression of the brachial plexus with scalenectomy and detachment of the pectoralis minor tendon from the coracoid process through a second incision above the coracoid process. No patient presented with a cervical rib or bony anomaly of the cervical spine. The diagnosis was based on clinical presentation, imaging studies, electromyography, and dynamic color Doppler ultrasound (triplex) of the subclavian artery in 90? and 120? abduction of the affected limb. All patients underwent physical therapy sessions for 3–6 months preoperatively without clinical improvement. Postoperatively, the upper limb was suspended with movement allowed within pain limits. Patients were clinically assessed at 1, 3, 6, and 12 months postoperatively. The outcomes were classified as satisfactory with complete symptom relief, good with symptom reduction, and poor in patients with no clinical improvement.

The mean follow-up time was 15 months (range 11–20). No postoperative infections or pneumothorax were observed. Two patients developed hematomas that did not require surgical drainage. No postoperative nerve injuries were noted. The outcomes were excellent with complete symptom resolution in 75% of cases, good with partial symptom resolution in 16.6%, and poor with no symptom improvement in 8.3%. The mean preoperative VAS score was 6, while the postoperative score was 1. The mean preoperative and postoperative DASH scores were 70 and 38, respectively.

TOS is a demanding pathology whose treatment requires of high expertise. Electric potentials contribute to the identification of each nerve branch.

TOS requires careful differential diagnosis and surgical expertise. It reduces the functionality of the upper limb and causes significant discomfort to the patient. Surgical intervention leads to good outcomes with symptom reduction or resolution, improving the patients quality of life. Supraclavicular and coracoid release of the brachial plexus is indicated in cases without cervical ribs or bony anomalies in the area.