title: [Gilliatt-Sumner hand or true neurogenic thoracic outlet syndrome. A report on seven operated cases].
abstract: OBJECTIVE
  The clinical picture of hand atrophy related to a cervical rib or elongated C7 transverse process was well described in the modern literature by Gilliatt and Sumner; in 1970, they reported a series of nine patients whose motor status was stabilized following brachial plexus decompression. We report here seven patients suffering from thoracic outlet syndrome (TOS), who developed hand atrophy, sometimes because of diagnostic delay.
  
  
  METHODS
  The patient's charts were analysed retrospectively.
  
  
  RESULTS
  The seven patients were all female; the mean age was 43 years. The first complaints were arm pain and paresthesias lasting six months to 5 years. Three patients were treated with C56/C67 discectomy plus disc prosthesis (one patient), ulnar neurolysis at the elbow (the same patient), carpal tunnel release (one patient), and intravenous immunoglobulins (one patient) before TOS diagnosis. Hand atrophy, severe in five patients, was present at presentation. All patients underwent brachial plexus decompression by the anterior (four), posterior (two), or transaxillary (one) approach. This last approach was completed 18 months later by brachial plexus neurolysis via the anterior approach. Postoperatively, motor deficit was improved in two patients and stabilized in five patients.
  
  
  CONCLUSIONS
  Physicians' unfamiliarity with TOS diagnosis or their reluctance to accept the diagnosis without electrical confirmation can lead to hand atrophy. Brachial plexus decompression at this stage usually stabilizes the deficit.
authors.affiliation: Service de neurochirurgie, CHU de Liège, domaine universitaire du Sart Tilman, Liège, Belgium. A.Dubuisson@chu.ulg.ac.be
authors.forename: A
authors.initials: A
authors.lastname: Dubuisson
authors.forename: M
authors.initials: M
authors.lastname: Nguyen Khac
authors.forename: F
authors.initials: F
authors.lastname: Scholtes
authors.forename: T
authors.initials: T
authors.lastname: Racaru
authors.forename: B
authors.initials: B
authors.lastname: Kaschten
mesh_terms: D000328:Adult; D001284:Atrophy; D001917:Brachial Plexus / Q000601:surgery; D019299:Decompression, Surgical; D057210:Delayed Diagnosis; D017586:Diskectomy; D004568:Electrodiagnosis; D004576:Electromyography; D005260:Female; D006225:Hand / Q000473:pathology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008875:Middle Aged; D009069:Movement Disorders / Q000601:surgery; D019919:Prosthesis Implantation; D011859:Radiography; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous