Neurosurgery: Thoracic outlet syndrome by Dr. Bosnjak

Dr. Roman BOSNJAK, Neurosurgery, UMC Ljubljana, Slovenia. roman.bosnjak@gmail.com Thoracic outlet syndrome (neurogenic TOS)is pain in the shoulder, arm, medial forearm and ulnar part of the hand, the 5th anfd 4th fingers. This position dependent and extravertebral brachialgia is a compression of the inferior trunk of the brachial plexus by rudimental cervical rib and fibrous band (from the rib to the 1st rib). The pain is accompanied by hyposensitivity on the medial forearm, hand an 4-5th fingers, sometimes atrophy of small hadn muscles is obvious. Sometimes vascular symptoms (hand paleness or hand bluish) may appear from subclavian artery or vein compression (vascular TOS). This video shows operative procedure that decompresses brachial plexus.

Category:

Education

Tags:

• neurosurgery
• thoracic
• outlet
• syndrome
• brachial
• plexus
• surgery
• cervical
• rib
• arm
• pain
• shoulder
• Bosnjak

[tmc515]

What approach is this? What approach is suggested for 1st rib removal for TOS?

[skybond007]

This si supra-clavicular approach (left-sided in this case). A 5-6 cm incision is made parallel and just above the clavicle between the strenocleidomastoid muscle and trapezius (subclavian triangle).

The same approach is used for 1st rib removal - only up to 3cm segment of the 1st rib is removed just below the inferior trunk. This is rarely indicated.

[all66books]

@annakara Yours' seems to be the only success story of all the posts I've seen! I have TOS bilaterally after years of heavy weightlifting. Where did you have your surgery?

[melanieinengland]

very good video, i had two operation on my rightside, i'm left with so much pain, i'm on nerve blocking pills (gabapentin ) for a week now 2 days on (Lyrica) Both have left me feeling drunk all the time. Please is there anything that anyone can suggest, T.O.S .If you have every broken a bone , the pain is awful, that is what i'm living with every day!

please help!!

I have looked on every site, thankyou for reading this statement.

[melanieinengland]

i had the extra rib on both sides, had surgery on my right side 4 years ago, then had surgery again 12 months later again on the right, lots of things went wrong after the surgery, 3 years later still in a great deal of pain.

i couldn't face anymore surgery as i nearlly died.

what do you think they could do for me now,

i had to see the surgeon this week, he said that they couldn't do anymore surgery.

i would love to go back to hairdressing, please help..

the video was very good, thankyou

[forum2cracka]

try the whole body. its one of the hardest professions to get into. good luck though.

[Alshaw33]

I aspire to become a neurosurgeon, and as I am now watching this video I am realizing all the anatomy that you must memorize. Not only in the brain, but along the spine, nervous system, and the back

[divabarbie82]

I was diagnosed with TOS when I was 17, in 1999. I was the drum major for marching band & the directing is where my symptoms started. I also ended up having the R and L rib removal. What I want to know, is where is the incision in this video? Mine are about 6 in. long & are under each armpit. TMC515, I feel your pain. I felt like I'd been hit by a truck when I woke up. Hospital time was 4 days, w a chest tube, in ATL. After that, it was a bout 6 wks b4 I could move my arms above my head.

[Tuliomurillo]

this is the approach I prefer; transaxilar I think is too elaborated and the exposure doesn`t give you as much view as with the supraclavicular. Nive video, very anatomic, thanks

[annakara]

Fascinating! I had this done in1997 after years of pain and severe muscle wastage in my hand. The operation was a success with minimal discomfort afterwards, and I was home within 48 hours. I have been pain free ever since and not a day goes by without my sincerest gratitude to the surgeons.

[locket07]

i had 2 extra ribs and had to have them removed im 18 now an still very poorly from them opertions i had to have a blood trasfuions aswell but im glad i watched this after i had it done

[tmc515]

I had this procedure done in 1990. It helped alleviate symptoms and pain of a left sided thoracic outlet. However, it felt like I was hit by a train when I awoke from the surgery (real long recovery). I always wanted to see how it was done. Thanks for posting the video!