André P Boezaart1, Allison Haller2, Sarah Laduzenski2, Veerandra B Koyyalamudi2, Barys Ihnatsenka2, Thomas Wright1
1 Department of Anesthesiology, Division of Acute Pain Medicine and Regional Anesthesia and Orthopaedic Surgery and Rehabilitation, University of Florida, College of Medicine, Gainesville, Florida, United States of American Society of Anesthesiologists, USA
2 Department of Anesthesiology, Division of Acute Pain Medicine and Regional Anesthesia, University of Florida, College of Medicine, Gainesville, Florida, United States of American Society of Anesthesiologists, USA
Neurogenic thoracic outlet syndrome (NTOS) is an oft-overlooked and obscure cause of shoulder pain, which regularly presents to the office of shoulder surgeons and pain specialist. With this paper we present an otherwise healthy young female patient with typical NTOS. She first received repeated conservative treatments with 60 units of botulinium toxin injected into the anterior scalene muscle at three-month intervals, which providing excellent results of symptom-free periods. Later a trans-axillary first rib resection provided semi-permanent relief. The patient was followed for 10 years after which time the symptoms reappeared. We review the literature and elaborate on the anatomy, sonoanatomy, etiology and characteristics, symptoms, diagnostic criteria and treatment modalities of NTOS. Patients with NTOS often get operated upon - even if just a diagnostic arthroscopy, and an interscalene or other brachial plexus block may be performed. This might put the patient in jeopardy of permanent nerve injury, and the purpose of this review is to minimize or prevent this.
André P Boezaart
Professor of Anesthesiology and Orthopaedic Surgery, Division of Acute Pain Medicine and Regional Anesthesia, PO Box 100254, 1600 SW Archer Road, Gainesville, Florida 32610
Source of Support: None, Conflict of Interest: None
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