Thoracic Outlet Decompression

Neurological thoracic outlet ‘inlet’ syndrome (TOS) involves compression of the brachial plexus through the thoracic inlet. The neurologic symptoms of TOS can range from mild paresthesias and numbness in the upper extremity to intrinsic hand muscle atrophy. Thoracic outlet decompression entails decompressing the upper, middle, and lower trunks by dividing the anterior and middle scalene through a supraclavicular approach. Upon exposure, the platysma is divided and the supraclavicular nerves are protected. Upon approach, the omohyoid is divided. Prior to dividing the scalenes, the phrenic and long thoracic nerves are identified and protected. In this particular case, the platysma was scarce. A tourniquet is seen during orientation as an ulnar nerve transposition followed the thoracic outlet decompression in this patient.

Standard:

Extended:

POSITION

Supine with an underlying shoulder bump to extend the neck.

INCISION

A supraclavicular incision that is 2 cm superior and parallel to the clavicle.

REFERENCES

1. Mackinnon SE, Novak CB. Thoracic outlet syndrome. Curr Probl Surg. 2002 Nov;39(11):1070-145. Review. PMID: 12407366.
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3. Mackinnon SE, Patterson GA. Supraclavicular first rib resection. Semin Thorac Cardiovasc Surg. 1996 Apr;8(2):208-13. PMID: 8672575.
4. Mackinnon SE, Novak CB. Evaluation of the patient with thoracic outlet syndrome. Semin Thorac Cardiovasc Surg. 1996 Apr;8(2):190-200. Review. PMID: 8672573.
5. Mackinnon SE, Patterson GA, Novak CB. Thoracic outlet syndrome: a current overview. Semin Thorac Cardiovasc Surg. 1996 Apr;8(2):176-82. Review. PMID: 8672571.
6. Mackinnon SE. Thoracic outlet syndrome: introduction. Semin Thorac Cardiovasc Surg. 1996 Apr;8(2):175. PMID: 8672570.
7. Novak CB, Collins ED, Mackinnon SE. Outcome following conservative management of thoracic outlet syndrome. J Hand Surg Am. 1995 Jul;20(4):542-8. PMID: 7594276.
8. Mackinnon SE, Novak CB. Clinical commentary: pathogenesis of cumulative trauma disorder. J Hand Surg Am. 1994 Sep;19(5):873-83. PMID: 7806822.
9. Mackinnon SE. Thoracic outlet syndrome. Ann Thorac Surg. 1994 Aug;58(2):287-9. PMID: 8067821.
10. Novak CB, Mackinnon SE, Patterson GA. Evaluation of patients with thoracic outlet syndrome. J Hand Surg Am. 1993 Mar;18(2):292-9. PMID: 8463597.

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.