Reference Values for the Scalene Interval Width During Varying Degrees of Glenohumeral Abduction Using Ultrasonography

Diagnostic ultrasonography of upper extremity dynamic compressive neuropathies in athletes: A narrative review

PURPOSE

This narrative review identifies and summarizes current evidence for diagnostic ultrasonographic evaluation of upper extremity dynamic compressive neuropathies affecting athletes.

METHODS

Relevant literature was identified using the PubMed database and then summarized.

RESULTS

The compressive neuropathies affecting athletes we identified included: neurogenic thoracic outlet syndrome, pectoralis minor syndrome, quadrilateral space syndrome, suprascapular nerve entrapment, proximal median nerve entrapment or bicipital aponeurosis/lacertus fibrosus (lacertus syndrome), radial tunnel syndrome, and cubital tunnel syndrome. Symptoms may develop only during specific sport activity, after specific sport-related trauma, or in setting of overuse during sport. Diagnostic ultrasound strategies assessing compressive neuropathies focus on static evaluation of nerves and surrounding structures, as well as dynamic evaluation of these structures in certain degrees of shoulder abduction, elbow flexion, or forearm pronation.

CONCLUSION

Ultrasonography can be used as a diagnostic tool in assessing upper extremity dynamic compressive neuropathies. Ultrasound allows for dynamic evaluation of these rare conditions, especially for athletes who primarily develop symptoms during movement or participation in sport.

Endoscopically assisted transaxillary release of the scalene muscles for thoracic outlet syndromes: a comparison with or without first rib resection

OBJECTIVES

There are several surgical techniques for thoracic outlet syndrome (TOS). However, there have been no reports of endoscopically assisted transaxillary release of the anterior and middle scalene muscles (EATRS), leaving the first rib intact for TOS. We hypothesized that EATRS would achieve a good Quick Disability of the Arm, Shoulder and Hand score. This study aims to present our experience with a new technique for TOS using endoscopy.

METHODS

We chose two surgeries depending on the patient's TOS condition. If the costoclavicular space was under 12 mm, we selected endoscopically assisted transaxillary first rib resection (EAFRR). If the costoclavicular space was over 12 mm, we selected EATRS. Between January 2021 and December 2022, 31 consecutive surgeries for TOS were performed in our institution. Twenty-five patients underwent EAFRR, and six (19%) underwent EATRS. Since July 2022, EAFRR has been performed under differential lung ventilation.

RESULTS

Complete and almost complete relief was achieved in 24 patients (77%), and partial relief was conducted in seven patients (23%) at a mean of 19.7 months after surgery. The symptoms improved in all cases. Intraoperative pneumothorax did not occur, and no other complications were observed. Both EAFRR and EATRS were effective and safe surgeries for TOS. Operative time was significantly shorter in EATRS than in EAFRR.

CONCLUSIONS

We first report EATRS surgery for TOS. EATRS is indicated for patients whose costoclavicular space is preserved before surgery. Good surgical results were obtained after surgery for this indication.

Ultrasound reference values of C5, C6, and C7 brachial plexus roots at the interscalene groove

OBJECTIVES

The objective of this study is to estimate the reference values of the brachial plexus roots at the interscalene groove. The physical and demographic characteristics of 59 healthy adult volunteers were studied. The CSA reference values and their correlations with weight, height, age, body mass index (BMI).

METHODS

Fifty nine (27 males, 32 females) subjects were enrolled in the study. The mean cross sectional area of C5, C6 and C7 nerve roots were obtained.

RESULTS

The mean CSA of the brachial plexus roots was as follows: C5 nerve root was 5.1 mm² (range 1.7-11.1 ± 1.9 SD), C6 nerve root CSA 5.8 mm² (range 1.7-12 ± 2.4 SD), and C7 nerve root 6.3 (range 1.6-19.6 ± 3.4 SD). There was a significant statistical difference between both sexes in our study. No statistical significant difference in tissue stiffness between dominant and nondominant hands. No statistical correlation was found between the CSA of the cervical nerve roots and different demographic factors. There was a positive statistical correlation between the CSA of C5 and both C6 and C7 nerve roots. Also positive significant statistical correlation was noted between the CSA of C6 and C7 nerve roots.

CONCLUSION

The CSA reference values of the C5-C7 nerve roots has been determined in asymptomatic individuals and can serve as a reference when studying pathological conditions of these structures.