Gilliatt-Sumner hand revisited: a 25-year experience.
OBJECTIVE
Thirty-three patients with true neurogenic thoracic outlet syndrome, or Gilliatt-Sumner hand, underwent surgical treatment at Louisiana State University during a 25-year period. This study retrospectively evaluated the outcome referable to pain and motor function in these patients.


METHODS
All patients had the typical Gilliatt-Sumner hand, secondary to compression of C8, T1, and/or lower trunk. Nineteen patients underwent an anterior supraclavicular approach, and 15 patients underwent a posterior subscapular approach to the brachial plexus. Nerve action potential recordings showed plexus involvement close to the spine, at the level of the junction of the spinal nerves to the lower trunk.


RESULTS
Pain, present in 22 patients, improved in 21. Mild motor deficit improved in 12 of 14 patients. Severe motor deficit improved partially in 14 of 20 patients.


CONCLUSIONS
The diagnosis of true neurogenic thoracic outlet syndrome provides a clear operative indication. Surgical decompression needs to involve the medial portion of the plexus, and especially the spinal nerves. An anterior supraclavicular approach is preferred in most cases. If there is a large cervical rib or there has been a prior anterior operation, then a posterior subscapular approach is indicated.
Department of Neurosurgery, Louisiana State University at New Orleans, New Orleans, USA.
Gabriel C
GC
Tender
Ajith J
AJ
Thomas
Najeeb
N
Thomas
David G
DG
Kline
D000200:Action Potentials / Q000502:physiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007432:Intraoperative Period / Q000379:methods; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D009474:Neurons / Q000473:pathology; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000601:surgery*; D013995:Time; D016896:Treatment Outcome