WHAT IS THE HEAD AND NECK-BEST-BRACHIAL PARADE?
From spinal cords and destined for the upper limb nerves as well as the vein and the artery that vascularisent the upper limb can during their journey between the neck and the arm be submitted to anatomical constraints. This risk area is called the head and neck-best-brachial parade. These anatomical constraints can be the result of several elements:
-An anatomical anomaly: side supernumerary, musculo-tendinous anomalies…
-Trauma: fracture hurt consolidated (nonUnion) collarbone, dislocated…
-Postural disorders: stand with shoulders drooping ("droopy syndrome'), excessive weight.
WHAT ARE THE CLINICAL MANIFESTATIONS?
The symptoms related to the head and neck-best-brachial Parade (SDCTB) syndrome are variable. They have to in common to be present at gestures repeated senior members including exercises their arms in the air.
They are based on the compressed elements:
-Neurological compression: pain, tingling, insensitivity, the driving force reduction, muscle of the hand… Based on the compressed nerve root signs may affect different parts of the upper limb.
-pressure compression: types of cramps in the hand pain or the front arm exercises repeated arms in the air (position of "top hands"), hand feel cold, white, or blue (in a context of repeated efforts) or in forms advanced at rest, and at the extreme, when blood pressure is very severe, onset of gangrene on the tips of the fingers.
-venous compression: appearance of a big arm of appearance brutal and prolonged in the case of phlebitis during repeated effort (Paget-Schroetter Syndrome) or intermittent during repeated efforts (Mac Laughlin syndrome).
These events can be associated together or isolated depending on the type of compression.
Note that the SDCTB can be bilateral in 30% of cases.
Finally the SDCTB is favored by certain professions or physical activities requiring limbs very repetitive gestures.
WHAT ARE THE CONSEQUENCES OF A SYNDROME OF THE PARADE?
When the compression is very advanced and unsupported, the consequences may include the type of compression:
-nervous compression: chronic shoulder pain, upper extremity; paralysis of the hand, anesthesia of the hand.
-pressure compression: repeated artery trauma can cause a thrombosis (occlusion) of the initially from a lack of blood more or less severe (ischemia). This lack of blood can lead to necrosis on the ends of the fingers.
-venous compression: the trauma of repeated vein can cause thrombosis (occlusion) of it led to a lack of drainage venous causing a big arms (edema).
WHAT ARE THE EXAMS HAS REALIZE?
The richness of the symptoms and causes of the SDCTB require a paraclinical important assessment:
- radiological assessment to find a bone abnormality: x-ray of the column and the sides or scanner.
- Vascular assessment: echo-doppler arterial, venous limbs made at rest and exercise, arterial and venous angiography at rest and exertion (angioscanner, MRI angio, medical or venography).
- Neurological Assessment: electromyogram.
- balance sheet to eliminate other causes: neck looking for a compression of the spinal or roots scanner or MRI.
WHEN SHOULD HE PROPOSED A REHABILITATION?
In the majority of cases, it must first provide a reeducation through physical therapy sessions. They aim to reduce the stresses in "re-opening" areas of pinching. This rehabilitation should last at least 6 months.
IN WHAT IS THE OPERATION?
The surgery has two objectives:
- The first is the so-called decompression surgery that will remove all the obstacles that are compressing the nerves, the artery and the vein: resection of a supernumerary, resection of the first rib, resection of the scalene muscles… These resections have no consequence for the patient.
- The second is the vessels reconstruction surgery when they are wronged.
WHEN SHOULD IT OPERATE?
Should be offered a so-called decompression surgery of immediately when there is an obvious anatomical anomaly (supernumerary side including), when there is a complicated vascular compression (venous thrombosis, blood thrombosis). In this latter figure, the so-called decompression surgery will be often associated with a gesture of reparation to the injured ship.
We can be finally brought to discuss an intervention when well managed rehabilitation is ineffective after 6 months.
WHAT ARE THE RISKS OF THE SURGERY?
The richness of the anatomical elements in this area exposes the patient during surgery to many complications:
- neurological complications:
-damage of the brachial plexus (paralysis of the upper limb, upper limb anesthesia, pain sequellaires).
-lesions of the phrenique nerve (nerve of the diaphragm).
-syndrome of Claude Bernard-Horner causing a problem opening of the eyelid and narrowing of the pupil.
-pneumothorax: the liberation of the coast which is affixed to the lung may result in a gap of air in the chest cavity called pneumothorax. This complication is mild and often treated by establishing a chest tube 24 to 48 hours to pick up the lung to the wall.
-chylothorax: there are the lymph nodes in this area which when they are traumatized can caused a flow of lymph in the rib cage called chylothorax. This flow will be processed when it is abundant by a diet without fat and possibly by a chest drain for several days.
-bleeding and bruising: dissection of the ships at this level can cause bleeding that may be compensated by any blood transfusions.
-the surgical scar can become complicated a local infection which can cause antibiotics.
AFTER THE SURGERY?
Hospitalization is usually 72 hours outside all complications.
The patient will benefit from care nursing bandages every two days for ten days.
The implementation of surgical glue will allow the patient to shower normally as soon as the day after the operation.
Physical therapy will be started as soon as possible. It will allow the patient to avoid that it blocks his shoulder immediately after by apprehension. Conversely, rehabilitation should not be painful to limit the risk of CRPS. Rehabilitation is usually 1 month.
The duration of the work stoppage is usually 1 month as well as the limits of the sport.
The patient will be in 2 months by the surgeon with an angiologique record.