Combined endoscopic treatment of patient with «terrible triade»: decompression of brachial plexus in thoracic aperture and interscalene space and arthroscopic subacromial spacer implantation. Clinical case
- Authors: Belyak E.A.1,2, Paskhin D.L.2, Lazko F.L.1,2, Prizov A.P.1,2, Lazko M.F.1,2, Zagorodniy N.V.1,3, Menshikov V.V.2
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Affiliations:
- Peoples’ Friendship University of Russia
- Buyanov Moscow City Clinical Hospital
- Priorov National Medical Research Center of Traumatology and Orthopedics
- Issue: Vol 29, No 4 (2022)
- Pages: 391-401
- Section: Clinical case
- URL: https://journals.rcsi.science/0869-8678/article/view/147842
- DOI: https://doi.org/10.17816/vto110980
- ID: 147842
Cite item
Abstract
BACKGROUND: Brachial plexus injury (plexopathy) is a fairly common problem in neurology, neurosurgery, traumatology and orthopedics. Compression of the brachial plexus usually develops in a narrow anatomical space: in the area of the small pectoral muscle, thoracic aperture, interspinous space. In several cases there is a combination of plexopathy and shoulder joint pathology. In a failure of conservative treatment, surgical intervention such as revision and decompression of the brachial plexus can be used. The development of endoscopic methods of decompression allows the minimization of soft tissue trauma, reduces the risk of complications, and accelerates and facilitates the recovery period.
CLINICAL CASE DESCRIPTION: Our aim was to describe a clinical case and monitor the results of combined endoscopic intervention in a patient with the "terrible triad": endoscopic decompression of the brachial plexus in the thoracic aperture and interlumbar space and arthroscopy of the shoulder joint with subacromial spacer placement at 6 months after surgery. Patient M., aged 64 years, with the consequences of right shoulder joint trauma: dislocation of the humeral head, damage of the shoulder rotator cuff and development of posttraumatic plexopathy of the right brachial plexus. The patient underwent repeated courses of conservative treatment without any pronounced effect for 1 year after injury. To confirm the diagnosis, the patient underwent electroneuromyography and ultrasound examination of the brachial plexus on the right side and magnetic resonance imaging of the right shoulder joint. After the examination, the patient underwent combined endoscopic intervention: arthroscopy of the shoulder joint with subacromial spacer placement and endoscopic decompression of the brachial plexus in the thoracic aperture and interlumbar space. According to the visual analogue scale (VAS) the intensity of pain syndrome before surgery was 7 cm, 6 months after surgery the intensity of pain decreased to 1 cm according to VAS. According to the disabilities of the arm, shoulder and hand scale (DASH), the degree of upper extremity dysfunction before surgery was 48 points; 6 months after surgery, it decreased to 16 points. The British Medical Research Council scale (BMRC) rated the degree of motor impairment at 3 preoperatively and 0 postoperatively. The degree of sensory impairment according to the Seddon Nerve Damage Rating Scale was 2 preoperatively and 3+ postoperatively. Range of motion in the shoulder joint before surgery: flexion — 110°, abduction — 95°, external rotation — 15°. Six months after surgery: flexion — 165°, abduction — 165°, external rotation — 45°.
CONCLUSION: The findings allow us to characterize the technique of one-stage arthroscopy of the shoulder joint and endoscopic decompression of the brachial plexus in the thoracic aperture and interlumbar space as low-traumatic and effective, creating conditions for restoration of the shoulder joint and upper extremity function as well as elimination of pain syndrome in the upper extremity.
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##article.viewOnOriginalSite##About the authors
Evgeniy A. Belyak
Peoples’ Friendship University of Russia; Buyanov Moscow City Clinical Hospital
Author for correspondence.
Email: belyakevgen@mail.ru
ORCID iD: 0000-0002-2542-8308
SPIN-code: 7337-1214
MD, Cand. Sci. (Med.), Department Assistant, Traumatologist-Orthopedist
Russian Federation, Moscow; MoscowDmitrij L. Paskhin
Buyanov Moscow City Clinical Hospital
Email: yas-moe@mail.ru
ORCID iD: 0000-0003-3915-7796
SPIN-code: 8930-1390
Neurosurgeon
Russian Federation, MoscowFjodor L. Lazko
Peoples’ Friendship University of Russia; Buyanov Moscow City Clinical Hospital
Email: maxim_lazko@mail.ru
ORCID iD: 0000-0001-5292-7930
MD, Dr. Sci. (Med.), Professor, Traumatologist-Orthopedist
Russian Federation, Moscow; MoscowAleksej P. Prizov
Peoples’ Friendship University of Russia; Buyanov Moscow City Clinical Hospital
Email: aprizov@yandex.ru
ORCID iD: 0000-0003-3092-9753
SPIN-code: 6979-6480
MD, Cand. Sci. (Med.), Associate Professor, Traumatologist-Orthopedist
Russian Federation, Moscow; MoscowMaksim F. Lazko
Peoples’ Friendship University of Russia; Buyanov Moscow City Clinical Hospital
Email: maxim_lazko@mail.ru
ORCID iD: 0000-0001-6346-824X
MD, Department Assistant, Traumatologist-Orthopedist
Russian Federation, Moscow; MoscowNikolay V. Zagorodniy
Peoples’ Friendship University of Russia; Priorov National Medical Research Center of Traumatology and Orthopedics
Email: zagorodniy51@mail.ru
ORCID iD: 0000-0002-6736-9772
SPIN-code: 6889-8166
MD, Dr. Sci. (Med.), Professor, Corresponding Member of RAS, Traumatologist-Orthopedist
Russian Federation, Moscow; MoscowValentin V. Menshikov
Buyanov Moscow City Clinical Hospital
Email: valentinmenschicov@gmail.com
ORCID iD: 0000-0002-1102-2016
Traumatologist-Orthopedist
Russian Federation, MoscowReferences
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