Among the most common types of nerve entrapment is Thoracic Outlet Syndrome (TOS) causing pain and weakness in the neck, shoulder, arm and hand.
Although all physicians understand the role of the spine problems in causing shoulder and arm pain, there is a great deal of controversy and confusion regarding the diagnosis of thoracic outlet syndrome. Nerve entrapment of the median nerve in the wrist at the carpal tunnel can affect the thumb and next two fingers - carpal tunnel syndrome. Entrapment of the ulnar nerve at the elbow is cubital tunnel syndrome. However between the spine and the elbow there are many nerves, crossing a long course when these nerves become entrapped or injured, the diagnosis may be TOS.
Thoracic outlet syndrome can affect the blood vessels, or the nerves or both. In the past, it has been easy to diagnose TOS affecting thed blood vessels - causing loss of blood flow when the arms are raised. However, diagnostic proof of TOS affecting the nerves has been considered unsatisfactory or very difficult to achieve. Now, the advent of MR Neurography and Open MR guided injections has revolutionized diagnosis and treatment in this field. With these techniques, Dr. Filler at the Institute for Nerve Medicine has shown that TOS can be divided into as many as six different types of nerve entrapment. Each of these can be reliably and confidently identified and new, minimally invasive treatments are now avaiable for each of these.
In the past, the only surgery widely offered for the treatment of TOS was resection of the first rib. This is a very invasive and difficult operation with an extended recovery period and a very significant risk of major injury to blood vessels, nerves or lung during the operation. Dr. Filler has shown that if the inidividual type of TOS affecting a patient is known in advance, then it is usually possible to plan a small, safe minimally invasive surgery to correct the problem - usually on an outpatient basis.
There are many diagnoses and treatments of thoracic outlet syndrome. Please investigate the articles in this section to learn more about individualized cases from the files of Dr. Filler.
Animation: Mid plexus fibrosis after first rib resection.
The elements of the brachial plexus both proximal and distal to the area of fibrosis demonstrate normal separation between the nerve elements.
At the area indicated by the two arrows, the elements are adherent to each other, and demonstrate some deviation from their normal course. An additional image in the plane of the plexus elements also demonstrated a posterior deviation at this point. Palpation of the plexus at this location confirmed a Tinel's sign and focal tenderness in the area suggested by this image.
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