#THORACIC OUTLET SYNDROME ARMPIT PAIN SKIN#

Several complications associated with the procedure has been reported, including cardiac injury, bar displacement, bar rejection reaction, hemothorax, and so on. This surgical procedure has practically improved functional as well as cosmetic consequences of the PE patients. Nuss introduced a minimally invasive surgical procedure to correct the PE in 1987. He did well and had no complaint during the following 1 year. Hypoesthesia and pain of upper arms were alleviated. One month later, his muscle strength was restored to level 4. Meanwhile, the patient was encouraged to do (arm/upper limb) exercises to restore the muscle strength. Vitamin 12 and vitamin B1 were given to nourish the brachial plexus. We then gave patient nonsteroidal anti-inflammatory drugs to alleviate pain. The patient rejected our advice due to the cosmetic reason. In order to treat this complication, we first advised the patient to remove the metal bar. The force from the metal bar elevated the first ribs.

We recognized the narrowed space between the first rib and the anterior scalene muscle after the correction of chest deformity. EMG showed that the brachial plexus was injured at the position of thoracic outlet. The CT arteriogram of subclavian artery demonstrated that the subclavian artery was partially compressed during right arm abduction and external rotation between the clavicle and the first rib (Figs.

We performed electromyogram (EMG) and CT arteriogram of subclavian arteries on patient to support the diagnosis. The radial pulses were still touchable with abduction maneuver.ģD reconstruction imaging by CT showed a better configuration after Nuss surgery. The signs seemed to be caused by compressions of the brachial plexus, subclavian arteries and veins as they exited the chest. After additional two month, the patient presented with weakness, numbness as well as pain in both arms. One month later, the patient had pain in both upper limbs and need somed onto reduce his pain. The patient was satisfied with the cosmetic appearance. The metal bar discharged on the 7th day (Figs. The postoperative chest X-ray was normal, and Haller index was 2.0 on CT film. A stainless-steel stabilizer was placed on both sides of the metal bar. Then the correction bar was introduced to its proper position and turned over so that the convexity faced anteriorly.

The introducer was slowly inserted from the right incision, advanced across the mediastinum and toward the left incision, and raised the sternum and the anterior chest wall to the desired position.

#THORACIC OUTLET SYNDROME ARMPIT PAIN SKIN#

Two skin incisions of 3 cm length were made along the intersections of the transverse and mid-axillary lines. The transverse lines were drawn from the deepest point of the sternum to mid-axillary lines at both sides. A correction bar of appropriate length and shape was selected according to the distance between both mid-axillary lines on the surface of the thorax. The patient signed informed consent and gave his permission to perform the Nuss procedure.Īfter general anaesthesia, patients were placed in a supine position with both arms abducted and the chest elevated. The preoperative Haller index was 4.7 measured on thoracic CT film. A27-year-old male with pectus excavatum, who had no hypoesthesia and weakness in both upper limbs, had the Nuss procedure performed in the Department of Thoracic Surgery, PLA Army General Hospital, Beijing.

Thoracic outlet syndrome armpit pain