2025 ISAKOS Biennial Congress ePoster
Arthroscopic Brachial Plexus Neurolysis for Neurogenic Thoracic Outlet Syndrome
Kristine R. Italia, MD, FPOA, Quezon City, Metro Manila PHILIPPINES
Jashint Maharaj, MBBS, FRSPH, Brisbane, QLD AUSTRALIA
Roberto Pareyon MEXICO
Mohammad Jomaa LEBANON
Kenneth Cutbush, MBBS, FRACS, FAOrthA, Spring Hill, QLD AUSTRALIA
Ashish Gupta, MBBS, MSc, FRACS, FAORTHOA, Brisbane, QLD AUSTRALIA
Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, QLD, AUSTRALIA
FDA Status Not Applicable
Summary
This study aims to present the outcomes of arthroscopic brachial plexus neurolysis in patients who had failed conservative management for neurogenic TOS.
ePosters will be available shortly before Congress
Abstract
Introduction
Thoracic outlet syndrome (TOS) poses a difficult challenge to physicians largely due its non-specific and variable nature of symptoms. Currently, conservative management is the first line of treatment. This involves physiotherapy and pharmacologic therapy. Unfortunately, there remain many patients who have had multiple visits to different specialists as these current treatment options have failed to provide adequate and reliable outcomes. Surgical management is reserved for those who have failed conservative management. This study aims to present the outcomes of arthroscopic brachial plexus neurolysis in patients who had failed conservative management for neurogenic TOS.
Methods
Consecutive patients who underwent arthroscopic brachial plexus neurolysis performed by a senior fellowship-trained shoulder surgeon from February 2017 to September 2022 were included in the study. Clinical and functional outcomes including range of motion, pain Visual Analogue Score (VAS), Constant Score and American Shoulder Elbow Society (ASES) Score were collected preoperatively and postoperatively at 6 months, 12 months, and 2 years.
Results
A total of 17 patients (21 shoulders) were included in the study, with mean age of 34 (range 19-45). 76% of the cohort were female, and 24% had bilateral involvement. At a mean follow-up of 11 months, significant improvement in pain was noted (2.9 vs 5.8 preop). Range of motion also improved compared to preop (forward flexion 167 vs 136, lateral elevation 147 vs 122, external rotation 64 vs 54, internal rotation 67 vs 52). Constant score also improved from 40 to 64, as well as ASES (73 from 54) and UCLA 26 from 15. Satisfaction rate is at 81%. Those who were not satisfied and presented with persistent pain had secondary pathologies such as subclavian thrombosis, rudimentary rib, glenohumeral arthritis, and development of postoperative frozen shoulder. No neurovascular complications were noted in all patients.
Conclusion
Arthroscopic brachial plexus neurolysis is an effective procedure to address neurogenic thoracic outlet syndrome after failed conservative management. There is good satisfaction rate after arthroscopic neurolysis. Those with secondary pathologies may be expected to present with persistent symptoms postoperatively. Overall, it is a safe procedure; however, it requires a high level of arthroscopic skills.