Biomedical subjects
Publications and source records attributed to Marwan A Wehbé.
Conservative treatment of thoracic outlet syndrome consists initially of pain control and medicinal and physical measures. Therapy then addresses tight muscles, with strengthening of weakened neck and shoulder girdle muscles. Range of motion and nerve gliding exercises are instituted simultaneously, and the patient is educated in proper posture and ergonomics at home and in the work setting.
The authors' approach to patients with TOS starts with a thorough evaluation, including a detailed history, physical examination, electromyography, and radiographs. Once the work-up is complete a treatment plan is formulated with the patient. All diagnoses are prioritized, together with various options for treatment of each. Therapy is initiated when appropriate and a surgical plan addresses the worst nerve entrapments sequentially. The authors' favored procedure for TOS release is an anterior scalenectomy with epineurectomy, with decompression of any structures impinging on the brachial plexus. The authors encourage patients to attend therapy for approximately 3 months after surgery, and to follow a home program of rehabilitation to maximize their gains and decrease the chance of recurrence.
The brachial plexus may be visualized simply as beginning with five nerves and terminating in five nerves. It begins with the anterior rami of C5, C6, C7, C8, and the first thoracic nerve. It terminates with the formation of the musculocutaneous, median, ulnar, axillary, and radial nerves. The intermediate portions are displayed in sets of threes: three trunks are formed, followed by three divisions, then three cords. Each trunk gives rise to two divisions and each cord gives rise to two branches. The lateral cord divides into the musculocutaneous nerve and the lateral branch of the median nerve. The medial cord divides into the medial branch of the median nerve and the ulnar nerve. The posterior cord divides into the axillary and the radial nerves. The anatomy of the brachial plexus can be confusing, especially because of frequent variations in length and caliber of each of its components.
Nerve gliding exercises (NGE) are an important part of the treatment of thoracic outlet syndrome (TOS), whether conservative or surgical. They also can be useful for other peripheral nerve problems.
Even though the response from this survey was decent, it is not large enough to draw statistical conclusions. The data therefore are being presented from an interest standpoint and do reflect the current trends of treatment for TOS. Physicians who do not treat TOS do not have an accurate view of this disorder, its treatment, or the success rate of treatment. Surgeons who deal with this problem have encouraging results. Conservative treatment seems effective in approximately half of the patients afflicted with this condition. Surgery carries what seems to be a long-term cure rate of 65% and partial relief in 20% of patients. Significant complications are rare.