Introduction: Thoracic outlet syndrome is a general term for a collection of nerve and vessel impingements affecting the neck shoulder, arm and hand. Surgical treatments such as first rib resection and scalenectomy are promising but percutaneous treatment would be preferable. Scalene injections are difficult, widely offered, but generally of limited effectiveness. New MRI guided interventions were developed that have greatly increased the long term and permanent relief rate.
Methods: Fifty consecutive patient with symptomatic brachial plexus entrapment syndromes were evaluated by physical exam and MR Neurography. Patients then had percutaneous interventional MR procedures involving treatment of anterior scalene, middle scalene, levator scapula, and/or serratus anterior muscles or distal plexus, long thoracic nerve, axillary nerve or proximal plexus with marcaine, celestone, hyaluronidase and botulinum toxin type A. Pre-treatment and post-treatment analog pain scale, pain diagram and modified Oswestry data were evaluated.
Results: Among the 50 patients, 76% obtained relief of symptoms for more than 20 weeks constituting a sustained improvement of 3 points or more on the analog pain scale. 58% of the 50 patients obtained relief for greater than 3 months. 36% of the 50 patients obtained sustained relief greater than one year or permanently.
Conclusions: Utilizing open MR guidance to assure adequacy of injection, including hyaluronidase and botox, and treating a variety of targets depending on individual patient symptoms resulted in outcomes that outperform the effectiveness of a variety of previously reported percutaneous and open interventions for this condition.
Patient Care: This a great reduction in complication risk and great increase in treatment efficacy when compare to previously reported outcome studies for this condition.
Learning Objectives: Interventional MRI can provide improved access and assure optimized treatment for percutaneous treatment of thoracic outlet syndrome.