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Pectoralis minor syndrome – review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome

Thoracic outlet syndrome is an umbrella term for compressive pathologies in the supraclavicular and infraclavicular fossae, with the vast majority being neurogenic in nature. These compressive neuropathies, such as pectoralis minor syndrome, can be challenging problems for both patients and physicia...

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Autores principales: Ahmed, Adil S., Graf, Alexander R., Karzon, Anthony L., Graulich, Bethany L., Egger, Anthony C., Taub, Sarah M., Gottschalk, Michael B., Bowers, Robert L., Wagner, Eric R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426640/
https://www.ncbi.nlm.nih.gov/pubmed/37588453
http://dx.doi.org/10.1016/j.xrrt.2022.05.008
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author Ahmed, Adil S.
Graf, Alexander R.
Karzon, Anthony L.
Graulich, Bethany L.
Egger, Anthony C.
Taub, Sarah M.
Gottschalk, Michael B.
Bowers, Robert L.
Wagner, Eric R.
author_facet Ahmed, Adil S.
Graf, Alexander R.
Karzon, Anthony L.
Graulich, Bethany L.
Egger, Anthony C.
Taub, Sarah M.
Gottschalk, Michael B.
Bowers, Robert L.
Wagner, Eric R.
author_sort Ahmed, Adil S.
collection PubMed
description Thoracic outlet syndrome is an umbrella term for compressive pathologies in the supraclavicular and infraclavicular fossae, with the vast majority being neurogenic in nature. These compressive neuropathies, such as pectoralis minor syndrome, can be challenging problems for both patients and physicians. Robust understanding of thoracic outlet anatomy and scapulothoracic biomechanics are necessary to distinguish neurogenic vs. vascular disorders and properly diagnose affected patients. Repetitive overhead activity, particularly when combined with scapular dyskinesia, leads to pectoralis minor shortening, decreased volume of the retropectoralis minor space, and subsequent brachial plexus compression causing neurogenic thoracic outlet syndrome. Combining a thorough history, physical examination, and diagnostic modalities including ultrasound-guided injections are necessary to arrive at the correct diagnosis. Rigorous attention must be paid to rule out alternate etiologies such as peripheral neuropathies, vascular disorders, cervical radiculopathy, and space-occupying lesions. Initial nonoperative treatment with pectoralis minor stretching, as well as periscapular and postural retraining, is successful in the majority of patients. For patients that fail nonoperative management, surgical release of the pectoralis minor may be performed through a variety of approaches. Both open and arthroscopic pectoralis minor release may be performed safely with effective resolution of neurogenic symptoms. When further indicated by the preoperative workup, this can be combined with suprascapular nerve release and brachial plexus neurolysis for complete infraclavicular thoracic outlet decompression.
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spelling pubmed-104266402023-08-16 Pectoralis minor syndrome – review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome Ahmed, Adil S. Graf, Alexander R. Karzon, Anthony L. Graulich, Bethany L. Egger, Anthony C. Taub, Sarah M. Gottschalk, Michael B. Bowers, Robert L. Wagner, Eric R. JSES Rev Rep Tech Review and Full-Length Article Thoracic outlet syndrome is an umbrella term for compressive pathologies in the supraclavicular and infraclavicular fossae, with the vast majority being neurogenic in nature. These compressive neuropathies, such as pectoralis minor syndrome, can be challenging problems for both patients and physicians. Robust understanding of thoracic outlet anatomy and scapulothoracic biomechanics are necessary to distinguish neurogenic vs. vascular disorders and properly diagnose affected patients. Repetitive overhead activity, particularly when combined with scapular dyskinesia, leads to pectoralis minor shortening, decreased volume of the retropectoralis minor space, and subsequent brachial plexus compression causing neurogenic thoracic outlet syndrome. Combining a thorough history, physical examination, and diagnostic modalities including ultrasound-guided injections are necessary to arrive at the correct diagnosis. Rigorous attention must be paid to rule out alternate etiologies such as peripheral neuropathies, vascular disorders, cervical radiculopathy, and space-occupying lesions. Initial nonoperative treatment with pectoralis minor stretching, as well as periscapular and postural retraining, is successful in the majority of patients. For patients that fail nonoperative management, surgical release of the pectoralis minor may be performed through a variety of approaches. Both open and arthroscopic pectoralis minor release may be performed safely with effective resolution of neurogenic symptoms. When further indicated by the preoperative workup, this can be combined with suprascapular nerve release and brachial plexus neurolysis for complete infraclavicular thoracic outlet decompression. Elsevier 2022-06-30 /pmc/articles/PMC10426640/ /pubmed/37588453 http://dx.doi.org/10.1016/j.xrrt.2022.05.008 Text en © 2022 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review and Full-Length Article
Ahmed, Adil S.
Graf, Alexander R.
Karzon, Anthony L.
Graulich, Bethany L.
Egger, Anthony C.
Taub, Sarah M.
Gottschalk, Michael B.
Bowers, Robert L.
Wagner, Eric R.
Pectoralis minor syndrome – review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome
title Pectoralis minor syndrome – review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome
title_full Pectoralis minor syndrome – review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome
title_fullStr Pectoralis minor syndrome – review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome
title_full_unstemmed Pectoralis minor syndrome – review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome
title_short Pectoralis minor syndrome – review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome
title_sort pectoralis minor syndrome – review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome
topic Review and Full-Length Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426640/
https://www.ncbi.nlm.nih.gov/pubmed/37588453
http://dx.doi.org/10.1016/j.xrrt.2022.05.008
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