Liu J E, Tahmoush A J, Roos D B, Schwartzman R J
Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
J Neurol Sci. 1995 Feb;128(2):175-80. doi: 10.1016/0022-510x(94)00220-i.
Fourteen patients were identified with (1) pain and sensory changes in a brachial plexus distribution, (2) aggravation of pain with use of the affected extremity, and (3) pain on palpation over the brachial plexus. All patients had minimal or no intrinsic hand muscle atrophy. Only one patient had cervical ribs. Nerve conduction studies were normal, and electromyography (EMG) showed mild chronic neuropathic changes in 2 patients. None of the patients responded to conservative therapy over a prolonged period (7-12 months). A compressive brachial plexopathy from abnormally attached or enlarged scalene muscles that affected both upper and lower trunks of the brachial plexus was found at surgery in all patients. In 13 patients, at least one fibrous band compressed the lower trunk of the brachial plexus. Therefore, neurogenic thoracic outlet syndrome can occur from cervical bands and scalene muscle anomalies without intrinsic hand muscle atrophy, cervical ribs, enlarged C7 transverse processes, or EMG abnormalities.
（1）臂丛神经分布区域疼痛及感觉改变；（2）使用患侧肢体时疼痛加剧；（3）臂丛神经触诊时疼痛。所有患者手部固有肌肉萎缩轻微或无萎缩。仅一名患者有颈肋。神经传导研究结果正常，肌电图（EMG）显示2例患者有轻度慢性神经病变改变。所有患者经过长时间（7 - 12个月）的保守治疗均无反应。手术发现，所有患者均存在因异常附着或增大的斜角肌导致的压迫性臂丛神经病变，影响臂丛神经的上干和下干。13例患者中，至少有一条纤维带压迫臂丛神经下干。因此，神经源性胸廓出口综合征可由颈部束带和斜角肌异常引起，而无手部固有肌肉萎缩、颈肋、C7横突增大或肌电图异常。
