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Thoracic Outlet
Syndrome (TOS),
Winged Scapula,
12
Brachial Plexus
Compression
DELLON INSTITUTES FOR PERIPHERAL NERVE SURGERY ®
3333 N CALVERT ST, SUITE 370, BALTIMORE, MD 21218 T410 467 5400 F410 366 9826 delloninstitutes.com
you r c ompl ai nts are t r e at m e n t w i t h o u t s u r g e r y
Aching or pain in the shoulder. Alter your activities so you do not put your hands over-
head, and have better posture when typing (computer).
Numbness and tingling in any or all fingers.
Strengthen your shoulder girdle muscles (trapezium,
Doing any work with the hand over the head makes
rhomboid, serratus anterior).
your symptoms worse.
Stretch your tight neck muscle (anterior scalene).
Gradual loss of strength in the hand/arm.
Be sure there are no other problems present on your
Coldness in the hand or fingers.
chest x-ray that could cause pressure on your brachial
Headaches, cheek or facial pain, TMJ pain may plexus (tumor).
be present.
Be sure you do not have a cervical disc problem.
Your hand may swell.
w h e n s h o u l d i h av e
w h at c au s e s y o u r c o m p l a i n t s ? b r ac h i a l p l e x u s s u r g e ry ?
Five nerve roots from your cervical (neck) spine criss- When six months of guided physical therapy have
cross and rejoin again to form a switch-yard of nerves not helped.
called the Brachial Plexus in the side of your neck.
When vascular surgery testing demonstrates compres-
The brachial plexus enters the arm by crossing through sion of the subclavian artery or vein, which also goes
neck muscles that can become a source of compression. through this region, and can cause hand swelling
or coldness.
Raising the arm above the head further stretches these
nerves, decreasing their blood flow, and causing symptoms. When your symptoms persist despite surgical
decompression of any coexisting carpal or cubital
Some people are born with an extra cervical rib in the tunnel syndrome. (Please see the Carpal Tunnel and
middle of the brachial plexus. Cubital Tunnel brochures for more information.)
TOLL FREE 877-DELLON-1 THORACIC OUTLET SYNDROME DELLON INSTITUTES FOR PERIPHERAL NERVE SURGERY ® DELLONINSTITUTES.COM
w h at i s t h e s u r g e r y l i k e ? w h at d o e s t h e n e rv e l o o k l i k e ?
The surgery takes two hours. In the brachial plexus,
the five nerve roots
The surgery requires a one night stay in the hospital to from the neck separate
observe for problems with breathing or bleeding. into the main nerves
for the entire shoulder,
General anesthesia is used. arm, and hand. The
nerves cross through
A two inch incision is made in the neck, above the
muscles and go across
collar bone. the ribs and under the
collar bone. The main
All structures that compress the brachial plexus are
artery and vein to
removed, which always includes the anterior scalene the arm also travel
muscle. In the Dellon-approach, a first rib is not part of this path with
usually removed. the nerves.
If there is an extra rib (cervical rib), then it is removed. TOP RIGHT
The incision for this
If there is scarring, then microsurgery can be done to surgery is shown.
remove this. This is usually required for the supras-
BLUE DISK
capular nerve to the shoulder.
The anterior scalene
If there is winging of the scapula, then special attention muscle is removed to
relieve pressure on the
is paid to a neurolysis of the long thoracic nerve.
nerves of the brachial
A drain is put in your incision, and removed the plexus and on the
subclavian artery and
next day.
vein. The subclavian
You have immediate use of your hand and arm. artery and vein are
pictured bottom right.
Headaches and facial pain are often relieved the 1st week.
There may be residual numbness in your hand for
three months.
TOLL FREE 877-DELLON-1 THORACIC OUTLET SYNDROME DELLON INSTITUTES FOR PERIPHERAL NERVE SURGERY ® DELLONINSTITUTES.COM
CALL TOLL FREE w h at a r e t h e r i s k s o f s u r g e r ? b e i n g a c a d e m i c i n p r i vat e p r a c t i c e sm BROCHURES
877-DELLON-1 The published outcomes of the Dellon-approach to the Campbell, JN, Naff N, Dellon, AL: Thoracic Outlet Syndrome. Neurosurg IN THIS SERIES:
to find the location Clin North Amer 2:227-234, 1991.
treatment of brachial plexus compression in the thoracic
of the nearest Carpal Tunnel
inlet (thoracic outlet syndrome) offer the best success for Levin LS, Dellon AL: Pathology of the shoulder as it relates to the differ- Syndrome
Dellon Institute
relief of your symptoms. There are risks associated with ential diagnosis of thoracic outlet compression. J Reconstr Microsurg
every surgical procedure, such as the risk of anesthesia, 8:313-317, 1992. Cubital Tunnel
Syndrome
bleeding and infection. Complications unique to decom- Dellon AL: “Brachial plexus compression” (not “thoracic outlet
pression of the brachial plexus are: syndrome”): Treatment by supraclavicular plexus neurolysis. J Reconstr Foot Drop
Microsurg 9:11-18, 1993.
Transient loss of phrenic nerve function (difficulty Groin Pain
breathing can occur, especially in smokers). Wong L, Dellon AL: Brachial neuritis presenting as anterior interosseous
nerve compression – Implications for diagnosis and treatment: A case Heel Pain
Bleeding from the major blood vessels to the arm/hand. report. J Hand Surg 22A:536-539, 1997.
Joint Pain
The lung can collapse (pneumothorax), requiring a Disa J, Wang B, Dellon AL: Correction of scapular winging by neurolysis
Nerve Injury and
of the long thoracic nerve. J Reconstr Microsurg: 17: 79-84, 2001.
chest tube to evacuate air, and reinflate the lung. Repair
Howard M, Lee C, Dellon AL: Documentation of Brachial Plexus
There can be direct injury to branches of the Compression in the thoracic inlet utilizing provocation with Neurosen- Neuropathy
brachial plexus. sory and Motor Testing. J Reconstr Microsurg, 19:303-312, 2003.
Neurosensory
There may be remaining numbness in your fingers. Testing With
The Pressure-Specified
Sensory Device™
w h o s h o u l d d o t h i s s u r g e ry ? Radial Nerve
Entrapments
Surgeons from the Dellon Institutes for Peripheral
Nerve Surgery® have the most advanced training Tarsal Tunnels
and experience doing this surgery, which offers you Syndrome
the best chance for success.
Thoracic Outlet
Syndrome
TOLL FREE 877-DELLON-1 THORACIC OUTLET SYNDROME DELLON INSTITUTES FOR PERIPHERAL NERVE SURGERY ® DELLONINSTITUTES.COM
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