Muellner Julia, Kaelin-Lang Alain, Pfeiffer Oliver, El-Koussy Marwan Mohamed
Department of Neurology, University Hospital Bern, Freiburgstrasse 100, 3010, Bern, Switzerland.
Neurocenter of Southern Switzerland, Opsedale Civico, Via Tesserete 46, 6900, Lugano, Switzerland.
BMC Res Notes. 2015 Aug 14;8:351. doi: 10.1186/s13104-015-1317-3.
Neurogenic thoracic outlet syndrome is an underestimated cause of brachial weakness and pain. The subclavius posticus muscle (SPM) is an aberrant muscle originating from the medial aspect of the first rib reaching to superior border of the scapula, which may cause, depending on its activation, dynamic compression of the brachial plexus.
In the present study, we report about a 32-year-old male caucasian patient with weakness in radial deviation of his left hand. An isolated macrodactyly of his left middle finger had been operated twice. Electroneurography showed a carpal-tunnel-syndrome (CTS) on the left side. MRI of the brachial plexus revealed an additional muscle in the costoclavicular space, identified as SPM. To our knowledge, this is the second case report of a neurogenic thoracic outlet syndrome due to SPM, and the first case described with isolated macrodactyly and CTS in the same patient.
If complaints about hand weakness are only reported in cases of distinct hand positions, a dynamic compression of the brachial plexus by SPM may be the cause. A neurogenic thoracic outlet syndrome may facilitate the development of CTS.
神经源性胸廓出口综合征是导致臂丛神经无力和疼痛的一个被低估的原因。后斜角肌是一块变异肌肉，起于第一肋内侧，止于肩胛骨上缘，根据其激活情况，可能会导致臂丛神经的动态受压。
在本研究中，我们报告了一名32岁的白人男性患者，其左手桡侧偏无力。他的左手中指孤立性巨指畸形已接受过两次手术。神经电生理检查显示左侧腕管综合征（CTS）。臂丛神经磁共振成像显示在锁骨下间隙有一块额外的肌肉，经鉴定为后斜角肌。据我们所知，这是第二例因后斜角肌导致的神经源性胸廓出口综合征病例报告，也是首例在同一患者中描述同时存在孤立性巨指畸形和腕管综合征的病例。
如果仅在特定手部姿势时出现手部无力的主诉，后斜角肌对臂丛神经的动态压迫可能是病因。神经源性胸廓出口综合征可能会促使腕管综合征的发生。
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