Year 2020 Vol. 28 No 1




A.P. Romodanov Neurosurgery Institute 1, Kiev, Ukraine,
Zhytomyr Regional Hospital named after A.F. Gerbachevsky 2, Zhytomyr,
Institute of Traumatology and Orthopedics 3,
Kiev, Ukraine

Objective. To determine diagnostic criteria for objectifying the localization, nature and severity of pathological changes, improving treatment tactics for tunnel neuropathies of the upper limb at the proximal level.
Methods. The treatment results of 77 patients with the tunnel neuropathies of the upper limb at the proximal level from 2009 to 2018 were analyzed. The average age is 39.12.1 years (Mσ), among them 46 patients (59.7%) were women, 31 patients (40.3%) were men. Among the additional methods of examination, the ultrasound of the vessels of the upper limb and peripheral nerve trunks was used as well as magnetic resonance imaging (MRI) of the brachial plexus, cervical spine, multidetector computed tomography (MDCT). Neurophysiological parameters were evaluated according to needle and stimulation electromyography (EMG). Of the methods of surgical treatment, we used both decompression of nerves/plexuses and resection of a problem area of a nerve with its subsequent nerve grafting, or distal neurotization was used. The combination of nerve decompression with the implantation of the system for long-term epineural electrical stimulation was used in 25 cases (32.5%). Evaluation of the early results of surgical treatment was carried out in the first days after surgery, distant in the period from four months to six years.
Results. In determining the area and nature of the compression, the MRI data were essential. EMG allowed us to determine the functional state of nerves and muscles, to exclude other pathological processes and the level of damage. Positive results of surgical treatment in patients with thoracic outlet syndrome (TOS) were observed in 42 (76.4%) cases, with tunnel mononeuropathies in 20 (90.9%) patients.
Conclusions. Using the capabilities of modern diagnostic methods for compression neuropathies of the upper limb at the proximal level allows significantly correcting treatment tactics. An individual approach to the choice of treatment methods allows achieving a favorable restoration of the function of structures that have undergone compression.

Keywords: compression neuropathy, thoracic outlet syndrome, electroneuromyography, diagnostics, electrostimulation
p. 62-73 of the original issue
  1. Agasarov LG, Chuzavkova EA. Tunnelnye sindromy: kliniko-patologicheskaia kharakteristika, diagnostika i lechenie (obzor). RMZh. 1999;(3):49-53. (In Russ.)
  2. Zhulev NM. Nevropatii: ruk dlia vrachei. S-Petersburg: Izdat dom SPbMAPO; 2005. 320 p. (In Russ.)
  3. Orlando MS, Likes KC, Mirza S, Cao Y, Cohen A, Lum YW, Reifsnyder T, Freischlag JA. A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome. J Am Coll Surg. 2015 May;220(5):934-99. doi: 10.1016/j.jamcollsurg.2014.12.046
  4. Viswanath O, Simpao AF, Rosen GP. Cervical rib and the risk for undiagnosed thoracic outlet syndrome. J Anaesthesiol Clin Pharmacol. 2018 Jul-Sep;34(3):419-20. doi: 10.4103/joacp.JOACP_395_17
  5. Kuwayama DP, Lund JR, Brantigan CO, Glebova NO. Choosing surgery for neurogenic TOS: the roles of physical exam, physical therapy, and imaging. Diagnostics (Basel). 2017 Jun 23;7(2). pii: E37. doi: 10.3390/diagnostics7020037
  6. Assmus H. Timing and Decision-Making in Peripheral Nerve Trauma. In: Haastert-Talini K, Assmus H, Antoniadis G, editors. Modern Concepts of Peripheral Nerve Repair. Springer Internetional Publishing; 2017. p. 27-39. doi: 10.1007/978-3-319-52319-4_3
  7. Arányi Z, Csillik A, Böhm J, Schelle T. Ultrasonographic Identification of Fibromuscular Bands Associated with Neurogenic Thoracic Outlet Syndrome: The Wedge-Sickle Sign. Ultrasound Med Biol. 2016 Oct;42(10):2357-66. doi: 10.1016/j.ultrasmedbio.2016.06.005
  8. Singh VK, Jeyaseelan L, Kyriacou S, Ghosh S, Sinisi M, Fox M. Diagnostic value of magnetic resonance imaging in thoracic outlet syndrome. J Orthop Surg (Hong Kong). 2014 Aug;22(2):228-31. doi: 10.1177/230949901402200224
  9. Tsymbaliuk VI, Tretyak IB, Tsymbaliuk YuV. Restorative surgical treatment of peripheral nerve injuries with long-term direct electrical stimulation. Ukr Nevrol Zhurn. 2013;(4):82-86. (In Ukr.)
  10. Willand MP, Nguyen MA, Borschel GH, Gordon T. Electrical stimulation to promote peripheral nerve regeneration. Neurorehabil Neural Repair. 2016 Jun;30(5):490-96. doi: 10.1177/1545968315604399
  11. Gordon T, Chan KM, Sulaiman OA, Udina E, Amirjani N, Brushart TM. Accelerating axon growth to overcome limitations in functional recovery after peripheral nerve injury. Neurosurgery. 2009 Oct;65(4 Suppl):A132-44. doi: 10.1227/01.NEU.0000335650.09473.D3
  12. Koo J, MacEwan MR, Kang SK, Won SM, Stephen M, Gamble P, Xie Z, Yan Y, Chen YY, Shin J, Birenbaum N, Chung S, Kim SB, Khalifeh J, Harburg DV, Bean K, Paskett M, Kim J, Zohny ZS, Lee SM, Zhang R, Luo K, Ji B, Banks A, Lee HM, Huang Y, Ray WZ, Rogers JA. Wireless bioresorbable electronic system enables sustained nonpharmacological neuroregenerative therapy. Nat Med. 2018 Dec;24(12):1830-36. doi: 10.1038/s41591-018-0196-2
  13. Korus L, Ross DC, Doherty CD, Miller TA. Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation. J Neurol Neurosurg Psychiatry. 2016 Feb;87(2):188-97. doi: 10.1136/jnnp-2015-310420
  14. Dvali L, Mackinnon S. The role of microsurgery in nerve repair and nerve grafting. Hand Clin. 2007 Feb;23(1):73-81. doi: 10.1016/j.hcl.2007.02.003
Address for correspondence:
04050, Ukraine,
Kiev, Platon Mayboroda Str., 32,
A.P. Romodanov Neurosurgery Institute,
Department of Reconstructive Neurosurgery.
Tel.: +38(044) 483-12-53,
Ihor B. Tretyak
Information about the authors:
Tretiakova Albina I., MD, Head of the Department of Functional Diagnostics, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
Kovalenko Ihor V., Neurosurgeon, Zhytomyr Regional Hospital named after A.F. Gerbachevsky, Zhytomyr, Ukraine.
Tretiakov Roman A., Radiologist, Institute of Traumatology and Orthopedics, Kiev, Ukraine.
Tsymbaliuk Yuliya V., MD, Neurosurgeon, Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
Chebotariova Lidia L., MD, Professor, Honored Worker of Science and Technology of Ukraine, Head of the Department of Neurophysiology, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
Gatskiy Alexander A., PhD, Neurosurgeon, Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
Tsymbaliuk Iaroslav V., Neurosurgeon, Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
Tretyak Ihor B., MD, Head of the Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
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