Washington University in St. Louis, MO, USA.
University of Louisville, KY, USA.
Hand (N Y). 2024 Nov;19(8):1206-1213. doi: 10.1177/15589447231187088. Epub 2023 Jul 31.
Spontaneous shoulder-girdle pain and scapular winging/dyskinesis can be caused by several neuromuscular disorders identifiable by electrodiagnostic studies (EDX). We describe a group of adolescent athletes with this clinical presentation but normal EDX, followed by later development of neurogenic thoracic outlet syndrome (NTOS).
We identified patients referred for evaluation of NTOS that had a history of chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX. Each was refractory to conservative management and underwent supraclavicular decompression and brachial plexus neurolysis for NTOS. Functional disability was quantified by Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores.
There were 5 female patients with a mean age at symptom onset of 14.2 ± 0.4 years, including spontaneous severe pain in the shoulder, scapula, and arm, along with prominent scapular winging/dyskinesis, and normal EDX. Symptoms had persisted for 18.9 ± 4.0 months prior to referral, with pronounced upper extremity disability (mean QuickDASH, 54.6 ± 6.9). By 3 months after surgical treatment for NTOS, all 5 patients experienced near-complete symptom resolution, including scapular winging/dyskinesis, with markedly improved function (mean QuickDASH, 2.2 ± 1.3) and a return to normal activity.
A subset of patients with chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX may develop dynamic brachial plexus compression characteristic of NTOS, exhibiting an ischemic "Sunderland-zero" nerve conduction block for which surgical decompression can result in rapid and substantial clinical improvement. The presence of surgically treatable NTOS should be considered for selected patients with long-standing scapular winging/dyskinesis who fail conservative management.
自发性肩带疼痛和肩胛骨翼状/运动障碍可由几种可通过电诊断研究（EDX）识别的神经肌肉疾病引起。我们描述了一组具有这种临床表现但 EDX 正常的青少年运动员，随后发展为神经源性胸廓出口综合征（NTOS）。
我们确定了因慢性非创伤性肩带疼痛、肩胛骨翼状/运动障碍和正常 EDX 而被转介进行 NTOS 评估的患者。每位患者均对保守治疗无反应，并接受锁骨上减压和臂丛神经松解术治疗 NTOS。通过快速上肢和手部残疾问卷（QuickDASH）评分来量化功能障碍。
有 5 名女性患者，平均发病年龄为 14.2±0.4 岁，包括肩部、肩胛骨和手臂自发性剧烈疼痛，以及明显的肩胛骨翼状/运动障碍，EDX 正常。症状在转诊前持续了 18.9±4.0 个月，上肢功能明显受损（平均 QuickDASH 为 54.6±6.9）。在接受 NTOS 的手术治疗后 3 个月，所有 5 名患者均经历了几乎完全的症状缓解，包括肩胛骨翼状/运动障碍，功能明显改善（平均 QuickDASH 为 2.2±1.3），恢复了正常活动。
慢性非创伤性肩带疼痛、肩胛骨翼状/运动障碍和正常 EDX 的患者亚组可能会出现特征性的动态臂丛神经压迫，表现为缺血性“桑德兰德零”神经传导阻滞，手术减压可迅速显著改善临床症状。对于长期存在肩胛骨翼状/运动障碍且保守治疗无效的选定患者，应考虑存在可手术治疗的 NTOS。
