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Compression of the lower trunk of the brachial plexus by a cervical rib in two adolescent girls: case reports and surgical treatment.

Dahlin LB, Backman C, Düppe H, Saito H, Chemnitz A, Abul-Kasim K, Maly P - J Brachial Plex Peripher Nerve Inj (2009)

Bottom Line: Presence of a cervical rib in children is extremely rare, particularly when symptoms of compression of the lower trunk of the brachial plexus occur.We present two cases with such a condition, where two young girls, 11 and 16 years of age were treated by resection of the cervical rib after a supraclavicular exploration of the lower trunk of the brachial plexus.The procedure led to successful results, objectively verified with tests in a work simulator, at one year follow-up.

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Affiliation: Hand Surgery, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. lars.dahlin@med.lu.se

ABSTRACT
Presence of a cervical rib in children is extremely rare, particularly when symptoms of compression of the lower trunk of the brachial plexus occur. We present two cases with such a condition, where two young girls, 11 and 16 years of age were treated by resection of the cervical rib after a supraclavicular exploration of the lower trunk of the brachial plexus. The procedure led to successful results, objectively verified with tests in a work simulator, at one year follow-up.

No MeSH data available.


Related in: MedlinePlus

Surgical exposure and resection of the cervical rib on the right side of the 12 year old girl (Case 1). The brachial plexus was explored via a supraclavicular approach (arrow lower trunk; A), revealing the cervical rib (arrow; B), which was resected. The resected bone surface was concealed with bone wax (arrow; C). After exploration, the brachial plexus, particularly the lower trunk was no longer riding above the cervical rib (D). The resected cervical rib is shown in E.
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Figure 3: Surgical exposure and resection of the cervical rib on the right side of the 12 year old girl (Case 1). The brachial plexus was explored via a supraclavicular approach (arrow lower trunk; A), revealing the cervical rib (arrow; B), which was resected. The resected bone surface was concealed with bone wax (arrow; C). After exploration, the brachial plexus, particularly the lower trunk was no longer riding above the cervical rib (D). The resected cervical rib is shown in E.

Mentions: When the patient was 12 years old, the cervical rib and the brachial plexus on the right side was explored supraclavicularly. The inferior trunk was riding over the cervical rib while the subclavian artery was located ventral to the cervical rib and the bone formation (Fig. 3). The artery was not affected. The entire cervical rib including periosteum and fibrotic bands was resected. Thereafter, no anatomical structures disturbed the lower trunk. The postoperative events were uncomplicated, except initial pain during deep breath (conventional X-ray of the lungs showed no pathological findings). She was treated with the anti-inflammatory drug diclofenac to theoretically reduce new bone formation.


Compression of the lower trunk of the brachial plexus by a cervical rib in two adolescent girls: case reports and surgical treatment.

Dahlin LB, Backman C, Düppe H, Saito H, Chemnitz A, Abul-Kasim K, Maly P - J Brachial Plex Peripher Nerve Inj (2009)

Surgical exposure and resection of the cervical rib on the right side of the 12 year old girl (Case 1). The brachial plexus was explored via a supraclavicular approach (arrow lower trunk; A), revealing the cervical rib (arrow; B), which was resected. The resected bone surface was concealed with bone wax (arrow; C). After exploration, the brachial plexus, particularly the lower trunk was no longer riding above the cervical rib (D). The resected cervical rib is shown in E.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2742518&req=5

Figure 3: Surgical exposure and resection of the cervical rib on the right side of the 12 year old girl (Case 1). The brachial plexus was explored via a supraclavicular approach (arrow lower trunk; A), revealing the cervical rib (arrow; B), which was resected. The resected bone surface was concealed with bone wax (arrow; C). After exploration, the brachial plexus, particularly the lower trunk was no longer riding above the cervical rib (D). The resected cervical rib is shown in E.
Mentions: When the patient was 12 years old, the cervical rib and the brachial plexus on the right side was explored supraclavicularly. The inferior trunk was riding over the cervical rib while the subclavian artery was located ventral to the cervical rib and the bone formation (Fig. 3). The artery was not affected. The entire cervical rib including periosteum and fibrotic bands was resected. Thereafter, no anatomical structures disturbed the lower trunk. The postoperative events were uncomplicated, except initial pain during deep breath (conventional X-ray of the lungs showed no pathological findings). She was treated with the anti-inflammatory drug diclofenac to theoretically reduce new bone formation.

Bottom Line: Presence of a cervical rib in children is extremely rare, particularly when symptoms of compression of the lower trunk of the brachial plexus occur.We present two cases with such a condition, where two young girls, 11 and 16 years of age were treated by resection of the cervical rib after a supraclavicular exploration of the lower trunk of the brachial plexus.The procedure led to successful results, objectively verified with tests in a work simulator, at one year follow-up.

View Article: PubMed Central - HTML - PubMed

Affiliation: Hand Surgery, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. lars.dahlin@med.lu.se

ABSTRACT
Presence of a cervical rib in children is extremely rare, particularly when symptoms of compression of the lower trunk of the brachial plexus occur. We present two cases with such a condition, where two young girls, 11 and 16 years of age were treated by resection of the cervical rib after a supraclavicular exploration of the lower trunk of the brachial plexus. The procedure led to successful results, objectively verified with tests in a work simulator, at one year follow-up.

No MeSH data available.


Related in: MedlinePlus