Brachial plexus injuries with causalgia resulting from transaxillary rib resection
S. H. Horowitz
In each of four patients with suspected thoracic outlet syndromes, the
transaxillary approach to resection of the first thoracic and cervical ribs
resulted in severe and permanent damage to the brachial plexus. The most
severe sequela was causalgia. Weakness of the hand muscles, sensory
deficits, and autonomic dysfunction also occurred. Abuse of narcotic
analgesics was common. Two patients suffered severe psychological
depressions, with one committing suicide. Current enthusiasm with
transaxillary rib resections in cases of thoracic outlet syndrome should be
tempered by the possibility of severe and permanent injury to the brachial
plexus and intractable causalgia.
