Experience of brachial plexus endoscopic decompression in combination with shoulder joint arthroscopy

Belyak E.A.; Paskhin D.L.; Lazko F.L.; Prizov A.P.; Lazko M.F.; Zagorodniy N.V.

doi:https://doi.org/10.17116/endoskop202329061111

Belyak E.A.

Peoples’ Friendship University of Russia;
Buyanov Moscow City Clinical Hospital

SPIN RSCI: 7337-1214
ORCID: 0000-0002-2542-8308

Paskhin D.L.

Buyanov Moscow City Clinical Hospital

SPIN RSCI: 8930-1390
ORCID: 0000-0003-3915-7796

Lazko F.L.

Peoples’ Friendship University of Russia;
Buyanov Moscow City Clinical Hospital

SPIN RSCI: 8504-7290
ORCID: 0000-0001-5292-7930

Prizov A.P.

Peoples’ Friendship University of Russia;
Buyanov Moscow City Clinical Hospital

SPIN RSCI: 6979-6480
ORCID: 0000-0003-3092-9753

Lazko M.F.

Peoples’ Friendship University of Russia;
Buyanov Moscow City Clinical Hospital

ORCID: 0000-0001-6346-824X

Zagorodniy N.V.

Peoples’ Friendship University of Russia

SPIN RSCI: 6889-8166
ORCID: 0000-0002-6736-9772

Experience of brachial plexus endoscopic decompression in combination with shoulder joint arthroscopy

Authors:

Belyak E.A., Paskhin D.L., Lazko F.L., Prizov A.P., Lazko M.F., Zagorodniy N.V.

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Journal: Endoscopic Surgery. 2023;29(6): 111‑123

DOI: 10.17116/endoskop202329061111

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To cite this article:

Belyak EA, Paskhin DL, Lazko FL, Prizov AP, Lazko MF, Zagorodniy NV. Experience of brachial plexus endoscopic decompression in combination with shoulder joint arthroscopy. Endoscopic Surgery. 2023;29(6):111‑123. (In Russ.)
https://doi.org/10.17116/endoskop202329061111

Подписка 2026 Эндоскопическая хирургия (Endoscopic Surgery)

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ABSTRACT

BACKGROUND

Brachial plexus compression, causing plexopathy, is a commonly spread problem in neurosurgery and orthopaedics and occurs, as usual, in narrow anatomic spaces: area of pectoralis minor muscle, thoracic aperture, interscalene space. Plexopathy usually combines with shoulder joint pathology. In case of conservative treatment failure surgical treatment applied — brachial plexus decompression. Development of endoscopic technique of brachial plexus decompression in association with shoulder joint arthroscopy will allow to minimize surgical trauma, decrease the risk of complications, intensify and facilitate rehabilitation period.

OBJECTIVE

Follow-up and analyze the results of endoscopic brachial plexus decompression in association with shoulder joint arthroscopy, describe the developed surgical technique.

MATERIAL AND METHODS

For the period from 2019 to 2022 we operated 5 patients, which were performed endoscopic brachial plexus decompression in association with shoulder joint arthroscopy. Among them were 3 men (60%) and 2 women (40%). Mean age of patients was 61.2±9.8 years. 3 patients had compression at the area of pectoralis minor muscle (Wright’s syndrome), 1 patient with thoracic outlet syndrome and 1 patient with thoracic outlet syndrome combining with interscalene space syndrome. Patients also had combining ipsilateral shoulder joint pathology.

SURGICAL TECHNIQUE

Endoscopic treatment started with shoulder joint arthroscopy and correction of intraarticular pathology. Then was performed excision of rotator interval, release around coracoid process, detachment of pectoralis minor and brachial plexus decompression. After that we made detachment of lateral aspect of subclavian muscle from clavicle, approach to brachial plexus and its decompression at area of thoracic aperture. Then we performed approach to brachial plexus at interscalene space and decompression at this area.

RESULTS

At 6 months follow-up after surgery treatment was effective in 4 patients from 5 (80%). These patients had significant relief of pain syndrome, decrease of neurologic impairments and increase of upper extremity function. Severity of pain syndrome according to VAS scale decreased from 8±0.8 cm to 2.4±1.8 cm. Patients showed improvement of active range of motion in shoulder joint: flexion 157±23° (was 106±11°), abduction 159±24° (was 100±16°), external rotation 48±14° (was 23±4°). Level of upper extremity dysfunction according to DASH scale decreased from 72±9 points to 23±21 points. Four from five patients (80%) noticed regression of neurologic impairments and returned to normal domestic and moderate sport activity. Results of our study were comparable to the results of studies of Lafosse (2017), K. Furushima (2021), D. Haeni (2022) and others, what indicates to efficacy and perspectives of development of endoscopic methods of brachial plexus decompression.

CONCLUSION

Endoscopic brachial plexus decompression is an effective and low-traumatic method, which allows to perform neurolysis and decompression of brachial plexus at areas of pectoralis minor muscle, thoracic aperture and interscalene space with minimal traumatization of soft tissues, which can be combined with simultaneous shoulder joint arthroscopy. The method demands high arthroscopic skill and topographical anatomy knowledge.

Keywords:

brachial plexus

endoscopic neurolysis

decompression

neuropathy

neuropathic pain syndrome

shoulder arthroscopy

thoracic outlet syndrome

interscalene space

Authors:

Belyak E.A.

Peoples’ Friendship University of Russia;
Buyanov Moscow City Clinical Hospital

SPIN RSCI: 7337-1214
ORCID: 0000-0002-2542-8308

Paskhin D.L.

Buyanov Moscow City Clinical Hospital

SPIN RSCI: 8930-1390
ORCID: 0000-0003-3915-7796

Lazko F.L.

Peoples’ Friendship University of Russia;
Buyanov Moscow City Clinical Hospital

SPIN RSCI: 8504-7290
ORCID: 0000-0001-5292-7930

Prizov A.P.

Peoples’ Friendship University of Russia;
Buyanov Moscow City Clinical Hospital

SPIN RSCI: 6979-6480
ORCID: 0000-0003-3092-9753

Lazko M.F.

Peoples’ Friendship University of Russia;
Buyanov Moscow City Clinical Hospital

ORCID: 0000-0001-6346-824X

Zagorodniy N.V.

Peoples’ Friendship University of Russia

SPIN RSCI: 6889-8166
ORCID: 0000-0002-6736-9772

Received:

29.09.2022

Accepted:

10.01.2023

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