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 110513
Extended 110511
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.
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Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.