Lecture Title: Conservative Care Options for Patients With A Failed Thoracic Outlet Syndrome Surgery
The lectures will be on topics like surgery, acute care surgery, advancements in surgery, bariatric surgery, cardiac surgery, cardiovascular and thoracic surgery, general surgery, neurosurgery, obstetrics and gynecological surgery, ophthalmic surgery, oral and maxillofacial surgery, orthopedic surgery, otolaryngology, pediatric surgery, plastic surgery, plastic surgery, podiatric surgery, reconstructive surgery and rehabilitation medicine, surgical gynecology, transplant surgery and urologic surgery
Juri Teras, North Estonian Medical Centre, Estonia, Northern Europe
Claes Feinbaum, Orasis Pharmaceuticals and Fepasaet Group, USA
Giovanni Ussia, University of Bologna, Italy
Emad Aboud, Arkansas Neuroscience institute, USA
Joseph Varghese, Royal Bolton Hospital, United Kingdom
Petr Stadler, Na Homolce Hospital, Czech Republic
Bo Du, Shenzhen People’s Hospital, China
Boutros Karam, American University of Beirut, Lebanon
Charles Antinori, Inspira Health Network, United States
Azmi Marouf, King Abdulaziz University Hospital (KAUH), Saudi Arabia
K Kailash, University Hospital Crosshouse, UK
Michel Bou Chaaya, Pierre & Marie Curie University, Lebanon
Nvard Kocharyan, “Knowledge-based Society” NGO, Armenia
Hayk Papikyan, Armenia medical center, Armenia
Zori Saghyan, Stepanakert medical center, Armenia
Abstract: Conservative Care Options for Patients With A Failed Thoracic Outlet Syndrome Surgery by Dr James Stoxen DC., FSSEMM (hon) FWSSEM
Thoracic outlet syndrome is a compression syndrome of the thoracic outlet (inlet or compartment) which is a tunnel over the rib cage under the shoulder and that allows the safe passage of the subclavian artery, subclavian vein, and nerves of the brachial plexus that pass from the chest and neck area into the arm.
Indications for surgery include, failure of a carefully supervised physical therapy program, paget-schroetter syndrome, post-subclavian vein thrombosis, arterial compression, limb-threatening complications, long-term compression, and neurologic deficit and intractable pain.
A failed thoracic outlet syndrome surgery is one that yields recurring major symptoms after surgery. One author estimated that recurring major symptoms persist in 15–20 percent of patients. Another author has stated the return of symptoms after surgery is more than 40 percent and another author stated it was as high as 61.2 percent.
Both the supraclavicular and transaxillary approaches focus on the surgical resection of the anterior scalene muscle, the middle scalene muscle and the first rib because it is elevated into the neurovascular bundle. Studies quote the reasons for recurrence or failed thoracic outlet syndrome surgery are due to an incomplete resection of the rib, an inadequate deep compression, reattached scalene muscles, scar tissue and a bony regeneration around the first rib.
This lecture explores the possibility that thoracic outlet syndrome surgery fails because not only is the floor of the outlet elevated by the elevation of the first rib but also the roof of the outlet, the shoulder girdle has fallen into the outlet from weakness in the upper trapezius muscle and levator scapula muscle but it is also possible that the roof of the outlet shoulder girdle is being dragged into the outlet abnormal sustained contraction of the pectoralis minor muscle, biceps short head, coracobrachialis muscle, subclavius muscle lower trapezius muscle and latissimus dorsi muscle.
If only the anterior scalene muscle, the middle scalene muscle and the first rib are resected this only opens space in the floor of the thoracic outlet. If only the pectoralis minor is resected this could not completely address all the muscles that can cause compression of the outlet. That is because the biceps short head, coracobrachialis muscle, subclavius muscle lower trapezius muscle and latissimus dorsi muscle are not addressed.
In this presentation we will discuss the thoracic outlet anatomy, the etiology of thoracic outlet syndrome and why the incidence is increasing, and the results we have had by treating patients whos surgery for thoracic outlet syndrome has failed by addressing the cause of the depression of the shoulder girdle into the thoracic outlet with conservative care.