DOS 2019

DOS Kongressen 2019 · 209 Pectoralis Minor Syndrome Anders Kjørup, Klaus Bak Clinic of Handsurgery, Gentofte Hospital; Orthopaedic Department, Kysthospitalet Background: Thoracic outlet syndrome is a compression of the vessels and nerves to the upper limb. The most distale site of compression is the plexus brachialis under the pectoralis minor (PM) tendon. This can cause local pain and distal nerve affection of a second compression site in a “double crush” picture. Purpose / Aim of Study: - Materials and Methods: - Findings / Results: 23 y/o girl with a history of 10 years handball, playing as goalkeeper presenting with carpal tunnel syndrome. She is twice decompressed on the clinical picture but has recurrence of symptoms. Neurophysiology is neg- ative. On contact she presents with pain of the shoulder, scapula dyskinesia and fatigue of the hand on daily use. No nightly dysaesthesia. Continuous decreased sensibility of the median and radial nerve, together with decreased strength of high and low innervated muscles of same nerves. Positive Tinels of median nerve to infraclavicular level. Chest x-ray shows no cervical costa. MRI, EMG and nerve ultrasonography normal. On suspicion of pectoralis minor syndrome physiotherapy is initiated, worsening symptoms and following there is done ul- trasonic guide botox injections in the thickest part of the PM. After 2 weeks relieve of symptoms but recurrence after 2 months. Another injection is made but again recurrence after 2 months. Surgery with a deltopectoral approach, a PM tenotomy from processus coracoideus with shortning of the tendon, is done. Physiotherapy with PM exercises shows gradual recovery. The patient is seen 6 months postoperative with full recovery of shoulder function without pain or fatigue. Distal normal sensibility. Conclusions: Pectoralis minor syndrome (PMS) can present in a neurogenic disguise and can be difficult to classify. Rarely there will be a positive paraclinic picture. The patient history is often containing a trauma or sports with repeti- tive shoulder stress activity (handball, swimming and volleyball). Clinically there will be pain of the PM tendon and positive Tinels, “Upper Limb Tension Test” and “Elevated Arm Stress Test”. A pectoralis minor muscle bloc can be used as a diagnostic tool. Neurophysiologically examination of the medial antebrachial cutaneous nerve shows good results. Surgery has a high success rate with no recurrence. 166.