Recurrent neurogenic thoracic outlet syndrome stressing the importance of pectoralis minor syndrome.

Background: Although first described over 60 years ago, neurogenic pectoralis minor syndrome (NPMS) has only recently been noted to be present in over half the patients with a clinical diagnosis of neurogenic thoracic outlet syndrome (NTOS). Similarly, NPMS has also been observed in the majority of patients with recurrent NTOS. This study explores the role of pectoralis minor tenotomy (PMT) in patients with recurrent NTOS. Methods: A total of 86 patients with symptoms of recurrent NTOS, who had failed to improve on conservative management, were evaluated by history and physical examination for both NPMS and NTOS. Diagnostic tests included pectoralis minor muscle (PMM) blocks, scalene muscle blocks, and medial antebrachial cutaneous nerve (MAC) measurements. Surgery was either PMT alone or PMT plus brachial plexus decompression (BPD). Follow-up was 1 to 3 years. Results: All patients had multiple symptoms of pain, weakness, and paresthesia. Patients who qualified for PMT alone had slightly fewer symptoms t...