Document Detail


The forgotten pectoralis minor syndrome: 100 operations for pectoralis minor syndrome alone or accompanied by neurogenic thoracic outlet syndrome.
MedLine Citation:
PMID:  20471786     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Since 2005 when we became aware of pectoralis minor syndrome (PMS), more than 75% of patients diagnosed with neurogenic thoracic outlet syndrome (NTOS) also have neurogenic PMS (NPMS), and about 30% have only NPMS, without NTOS. METHODS: Diagnosis was made based on history, physical examination, pectoralis minor (PM), and scalene muscle blocks with lidocaine. Pectoralis minor tenotomy was performed as an outpatient procedure under local anesthesia with heavy sedation through a 5-7 cm transaxillary incision. RESULTS: The clinical picture included pain or tenderness in the anterior chest wall and axilla, together with physical findings of tenderness over the pectoralis minor tendon. Other symptoms were extremity pain, weakness, and paresthesia, similar to symptoms of NTOS. In 76 patients, 100 operations were performed: 48 for NPMS combined with NTOS and 52 for NPMS-alone. Features distinguishing the PM-alone group were fewer and milder occipital headaches, less neck pain, and fewer positive physical findings. Preoperatively, 85% of the of the PM-alone group were still employed compared to only 57% of the combined group (p=0.01). Success rates with 1-3-year follow-up for the PM-alone group were 90% good-excellent, 2% fair, and 8% failed; for the combined group success rates were 35% good-excellent, 19% fair, and 46% failed. All but one of the failures was immediate, only one was late. The only complication was 3 wound infections. Most patients returned to work within a few days. In the combined PMS/TOS group, most of the failed patients subsequently had thoracic outlet operations. CONCLUSION: PMS commonly accompanies NTOS and frequently exists alone. Its recognition is important as many patients with suspected NTOS can be treated successfully with a simple, essentially risk-free PM tenotomy. Should this fail, thoracic outlet decompression can always be performed at a later date.
Authors:
Richard J Sanders; Neal M Rao
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Publication Detail:
Type:  Journal Article     Date:  2010-05-14
Journal Detail:
Title:  Annals of vascular surgery     Volume:  24     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-19     Completed Date:  2010-10-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  701-8     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Surgery, Rose Medical Center, Health Science Center, University of Colorado, Denver, CO 80220, USA. rsanders@ecentral.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Colorado
Decompression, Surgical / adverse effects,  methods*
Diagnosis, Differential
Disability Evaluation
Electromyography
Employment
Female
Headache / etiology
Humans
Male
Middle Aged
Nerve Block
Nerve Compression Syndromes / complications,  diagnosis,  physiopathology,  surgery*
Orthopedic Procedures* / adverse effects
Pain / etiology
Paresthesia / etiology
Pectoralis Muscles / innervation,  surgery*
Physical Examination
Recurrence
Thoracic Outlet Syndrome / complications,  diagnosis,  physiopathology,  surgery*
Time Factors
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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