Thoracic Outlet Syndrome (TOS) presents a challenging clinical scenario marked by the compression of neurovascular bundles and blood vessels in the upper extremity. Neurogenic thoracic outlet syndrome (NTOS), the most common subtype, accounts for 80-90% of all TOS cases. Diagnosing and treating NTOS is complex and requires a comprehensive approach integrating patient history, clinical examination, and advanced imaging techniques.
Ultrasound imaging has emerged as a valuable tool in managing NTOS by providing real-time visualization of anatomical structures. However, the precise role of ultrasound in NTOS management is still under active investigation. Subtle changes in nerve roots and surrounding tissues crucial for accurate diagnosis often go undetected by conventional imaging methods, leading to diagnostic challenges and treatment delays.
The urgency for innovative treatment strategies for NTOS is underscored by its associated morbidity. While conservative measures like physical therapy and pain medications are common, they often fall short in providing effective relief for patients with true neurogenic NTOS. Ultrasound-guided hydrodissection of the nerve root has shown promise as a minimally invasive intervention that can accelerate symptom relief and improve clinical outcomes.
This study evaluated the effectiveness of ultrasound-guided hydrodissection of the C5 nerve root combined with prevertebral fascia incision for treating NTOS. The findings demonstrated that this approach led to significant improvements in pain intensity and functional status, as evidenced by reduced Visual Analog Scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores.
Patients diagnosed with NTOS underwent ultrasound-guided hydrodissection and fascia incision, resulting in sustained improvements in pain and function. The procedure involved three stages: anatomical localization and preparation, targeted hydrodissection and fascia incision, and multi-level neural decompression. Ultrasound assessments preoperatively, at 1 week, and 6 weeks post-treatment showed consistent improvements in clinical outcomes.
Compared to healthy controls, NTOS patients exhibited distinct ultrasonographic parameters, including thickened prevertebral fascia, reduced distance between the nerve root and fascia, and increased cross-sectional area of the C5 nerve root. These findings suggest nerve compression and edema, contributing to the sensory and motor deficits observed in NTOS patients.
The study highlighted the safety and efficacy of ultrasound-guided hydrodissection for NTOS, emphasizing its potential as a new treatment option. By reducing nerve compression and inflammation, this minimally invasive approach offers a promising avenue for improving outcomes in patients with NTOS.
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