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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.

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

Exploration of the brachial plexus through a supraclavicular approach on the left side of the 17 year old girl. After skin incision and incision of the fascia the brachial plexus (arrow; A) was located very superficially riding on the cervical rib (arrow; B) and with a distorted anatomy of the brachial plexus rather twisted and horizontally located on top of the cervical rib. The cervical rib was resected in pieces (large arrow cervical rib; small arrow fibrous tissue; C) and the surface of the remaining exposed bone was covered with bone wax. After resection of a cervical rib, the brachial plexus was no longer distorted by any structures and the subclavian artery could be observed (arrow in D). Photos taken from below with the left arm to the right and the head to the left.
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Figure 5: Exploration of the brachial plexus through a supraclavicular approach on the left side of the 17 year old girl. After skin incision and incision of the fascia the brachial plexus (arrow; A) was located very superficially riding on the cervical rib (arrow; B) and with a distorted anatomy of the brachial plexus rather twisted and horizontally located on top of the cervical rib. The cervical rib was resected in pieces (large arrow cervical rib; small arrow fibrous tissue; C) and the surface of the remaining exposed bone was covered with bone wax. After resection of a cervical rib, the brachial plexus was no longer distorted by any structures and the subclavian artery could be observed (arrow in D). Photos taken from below with the left arm to the right and the head to the left.

Mentions: The brachial plexus and the cervical rib of the patient were explored when the girl was 17 years. The brachial plexus was distorted at and adhered to the ventral edge of the cervical rib and the bony process from the first rib (Fig. 5). The main part of the cervical rib including the bone process from the first rib was resected after the lower trunk was lifted up (Fig. 5). The subclavian artery was not impinged by the bone formation. The direct postoperative events were without problems, but later she was investigated at the Department of Infectious Diseases due to fever of unknown origin. No cause of the fever was found and later she recovered completely. She was followed regularly as with Case One.


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)

Exploration of the brachial plexus through a supraclavicular approach on the left side of the 17 year old girl. After skin incision and incision of the fascia the brachial plexus (arrow; A) was located very superficially riding on the cervical rib (arrow; B) and with a distorted anatomy of the brachial plexus rather twisted and horizontally located on top of the cervical rib. The cervical rib was resected in pieces (large arrow cervical rib; small arrow fibrous tissue; C) and the surface of the remaining exposed bone was covered with bone wax. After resection of a cervical rib, the brachial plexus was no longer distorted by any structures and the subclavian artery could be observed (arrow in D). Photos taken from below with the left arm to the right and the head to the left.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Exploration of the brachial plexus through a supraclavicular approach on the left side of the 17 year old girl. After skin incision and incision of the fascia the brachial plexus (arrow; A) was located very superficially riding on the cervical rib (arrow; B) and with a distorted anatomy of the brachial plexus rather twisted and horizontally located on top of the cervical rib. The cervical rib was resected in pieces (large arrow cervical rib; small arrow fibrous tissue; C) and the surface of the remaining exposed bone was covered with bone wax. After resection of a cervical rib, the brachial plexus was no longer distorted by any structures and the subclavian artery could be observed (arrow in D). Photos taken from below with the left arm to the right and the head to the left.
Mentions: The brachial plexus and the cervical rib of the patient were explored when the girl was 17 years. The brachial plexus was distorted at and adhered to the ventral edge of the cervical rib and the bony process from the first rib (Fig. 5). The main part of the cervical rib including the bone process from the first rib was resected after the lower trunk was lifted up (Fig. 5). The subclavian artery was not impinged by the bone formation. The direct postoperative events were without problems, but later she was investigated at the Department of Infectious Diseases due to fever of unknown origin. No cause of the fever was found and later she recovered completely. She was followed regularly as with Case One.

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