Histopathological basis for neurogenic thoracic outlet syndrome: Laboratory investigation

R. Shane Tubbs, Robert G. Louis, Christopher T. Wartmann, Robert Lott, Gina D. Chua, David Kelly, Cheryl Ann Palmer, Mohammadali Mohajel Shoja, Marios Loukas, W. Jerry Oakes

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Object. To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression. Methods. Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42%) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs. Results. The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified. Conclusions. Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.

Original languageEnglish (US)
Pages (from-to)347-351
Number of pages5
JournalJournal of Neurosurgery: Spine
Volume8
Issue number4
DOIs
StatePublished - Apr 1 2008
Externally publishedYes

Fingerprint

Cervical Rib
Thoracic Outlet Syndrome
Brachial Plexus
Cadaver
Peripheral Nerves
Blood Vessels
Ribs
Fibrosis

Keywords

  • Brachial plexus
  • Cervical rib
  • Compression neuropathy
  • Thoracic outlet syndrome

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Tubbs, R. S., Louis, R. G., Wartmann, C. T., Lott, R., Chua, G. D., Kelly, D., ... Oakes, W. J. (2008). Histopathological basis for neurogenic thoracic outlet syndrome: Laboratory investigation. Journal of Neurosurgery: Spine, 8(4), 347-351. https://doi.org/10.3171/SPI/2008/8/4/347

Histopathological basis for neurogenic thoracic outlet syndrome : Laboratory investigation. / Tubbs, R. Shane; Louis, Robert G.; Wartmann, Christopher T.; Lott, Robert; Chua, Gina D.; Kelly, David; Palmer, Cheryl Ann; Mohajel Shoja, Mohammadali; Loukas, Marios; Oakes, W. Jerry.

In: Journal of Neurosurgery: Spine, Vol. 8, No. 4, 01.04.2008, p. 347-351.

Research output: Contribution to journalArticle

Tubbs, RS, Louis, RG, Wartmann, CT, Lott, R, Chua, GD, Kelly, D, Palmer, CA, Mohajel Shoja, M, Loukas, M & Oakes, WJ 2008, 'Histopathological basis for neurogenic thoracic outlet syndrome: Laboratory investigation', Journal of Neurosurgery: Spine, vol. 8, no. 4, pp. 347-351. https://doi.org/10.3171/SPI/2008/8/4/347
Tubbs, R. Shane ; Louis, Robert G. ; Wartmann, Christopher T. ; Lott, Robert ; Chua, Gina D. ; Kelly, David ; Palmer, Cheryl Ann ; Mohajel Shoja, Mohammadali ; Loukas, Marios ; Oakes, W. Jerry. / Histopathological basis for neurogenic thoracic outlet syndrome : Laboratory investigation. In: Journal of Neurosurgery: Spine. 2008 ; Vol. 8, No. 4. pp. 347-351.
@article{4c1933e566354f4da3dcfa6f768b8bde,
title = "Histopathological basis for neurogenic thoracic outlet syndrome: Laboratory investigation",
abstract = "Object. To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression. Methods. Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42{\%}) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs. Results. The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified. Conclusions. Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.",
keywords = "Brachial plexus, Cervical rib, Compression neuropathy, Thoracic outlet syndrome",
author = "Tubbs, {R. Shane} and Louis, {Robert G.} and Wartmann, {Christopher T.} and Robert Lott and Chua, {Gina D.} and David Kelly and Palmer, {Cheryl Ann} and {Mohajel Shoja}, Mohammadali and Marios Loukas and Oakes, {W. Jerry}",
year = "2008",
month = "4",
day = "1",
doi = "10.3171/SPI/2008/8/4/347",
language = "English (US)",
volume = "8",
pages = "347--351",
journal = "Journal of Neurosurgery: Spine",
issn = "1547-5654",
publisher = "American Association of Neurological Surgeons",
number = "4",

}

TY - JOUR

T1 - Histopathological basis for neurogenic thoracic outlet syndrome

T2 - Laboratory investigation

AU - Tubbs, R. Shane

AU - Louis, Robert G.

AU - Wartmann, Christopher T.

AU - Lott, Robert

AU - Chua, Gina D.

AU - Kelly, David

AU - Palmer, Cheryl Ann

AU - Mohajel Shoja, Mohammadali

AU - Loukas, Marios

AU - Oakes, W. Jerry

PY - 2008/4/1

Y1 - 2008/4/1

N2 - Object. To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression. Methods. Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42%) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs. Results. The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified. Conclusions. Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.

AB - Object. To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression. Methods. Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42%) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs. Results. The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified. Conclusions. Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.

KW - Brachial plexus

KW - Cervical rib

KW - Compression neuropathy

KW - Thoracic outlet syndrome

UR - http://www.scopus.com/inward/record.url?scp=41749109347&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=41749109347&partnerID=8YFLogxK

U2 - 10.3171/SPI/2008/8/4/347

DO - 10.3171/SPI/2008/8/4/347

M3 - Article

C2 - 18377320

AN - SCOPUS:41749109347

VL - 8

SP - 347

EP - 351

JO - Journal of Neurosurgery: Spine

JF - Journal of Neurosurgery: Spine

SN - 1547-5654

IS - 4

ER -