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Home > Vascular Annual Meeting^® > PP30. The Forgotten Pectoralis Minor Syndrome: Report of 100 Operations

PP30. The Forgotten Pectoralis Minor Syndrome: Report of 100 Operations

Richard J. Sanders1,2, Neal M .Rao3
1University of Colorado, Denver, CO; 2Rose Medical Center, Denver, CO; 3UCLA, Los Angles, CA

OBJECTIVES: Pectoralis minor syndrome (PMS), first described in 1945, is another cause of pain and paresthesia in the upper extremity. Its symptoms mimick thoracic outlet syndrome (TOS). Between 2005 and 2007, more than 75% of patients referred to us for TOS were found to have PMS, either alone or combinated with TOS. We report 100 PM tenotomy operations in these patients.

METHODS: There were 100 pectoralis minor (PM) tenotomies performed as the only procedure in 76 patients (24 bilateral). Diagnosis was made by history of pain or tenderness below the clavicle and in the axilla plus physical findings of tenderness over the PM tendon. Other common symptoms were upper extremity pain, paresthesia, and weakness, similar to symptoms found in TOS. Diagnosis was confirmed by a positive response to a PM muscle block with lidocaine. PM tenotomy was performed as an outpatient under local anesthesia with heavy sedation through a 5-7 cm transaxillary incision.

RESULTS: History and physical exam separated patients into two groups: 52 operations for PMS alone; 48 for combined PMS and TOS. Symptoms common to both groups were paresthesia and pain in upper extremity and anterior chest wall (p>0.05). Symptoms of occipital headache, neck and supraclavicular pain were present in 81-96% of the combined group but only 31-50% of the PM-alone group and were much milder in the later group (p<.001). PM tenderness was present in almost all patients in both groups, but positive responses to TOS provocative maneuvers were milder and less frequent in the PM-alone group (p<.008). 1-3 year success rates for PM-alone were 81% good-excellent, 11% fair, and 8% failed; for PMS&TOS group results were 31% good-excellent, 19% fair, and 50% failed. The only complications were three wound infections. Most patients returned to work within a few days. Subsequently thoracic outlet decompression was performed in 62% of failed patients in the PMS&TOS group.

CONCLUSIONS: PMS should be considered in all patients presenting with symptoms of TOS. The importance of recognizing PMS is that many of these patients can be successfully treated with a relatively risk-free procedure thereby avoiding more invasive thoracic outlet operations and their potential complications. When PMS accompanies TOS the two can be operated upon simultaneously.

AUTHOR DISCLOSURES: R.J. Sanders, None; N.M. Rao, None.