Combined endoscopic treatment of patient with «terrible triade»: decompression of brachial plexus in thoracic aperture and interscalene space and arthroscopic subacromial spacer implantation. Clinical case

BACKGROUND. Brachial plexus injury (plexopathy) is a commonly spread pathology in neurology, neurosurgery, trauma and orthopaedics. Compression of brachial plexus usually occurs in narrow anatomic spaces: area of pectoralis minor muscle, thoracic aperture, interscalene space. In some cases plexopathy combines with shoulder joint pathology. In case of conservative treatment failure operative treatment is necessary — revision and decompression of brachial plexus. Development of endoscopic methods of decompression will allow to minimize soft tissue injury, decrease the risk complications, promote and relieve rehabilitation period. CLINICAL CASE DESCRIPTION. Describe a clinical case and analyze the results of combined endoscopic treatment of a patient with «terrible triad»: endoscopic brachial plexus decompression at the areas of thoracic aperture and interscale space and shoulder joint arthroscopy with subacromial spacer implantation at 6 months follow-up after the surgery. Patient M., 64 years old, with consequences of shoulder joint trauma: dislocation of humeral head, rotator cuff rupture and posttraumatic brachial plexopathy. Patient underwent several courses of conservative treatment without significant effect during 1 year after trauma. For instrumental investigation he was performed electroneuro-myography and ultrasound of brachial plexus, magnetic resonance imaging of the shoulder joint. After investigation the patient was performed combined endoscopic treatment: arthroscopy of shoulder joint with subacromial spacer implantation and endoscopic decompression of brachial plexus in thoracic aperture and interscalene space. According to Visual Analogue Scale scale severity of pain before the surgery was 7 cm, 6 months after surgery decreased to 1 cm. According to the disabilities of the arm, shoulder and hand scale disability of upper extremity before the surgery was 48 points, 6 months after surgery decreased to 16 points. According to British Medical Research Council scale the level of movement impairment before the surgery was 3 points, after the surgery decreased to 0. The level of sensory dysfunction according to Seddon scale was 2 points, after the surgery became 3+ points. Range of motion in the shoulder joint before the surgery was: flexion 110°, abduction 95°, external rotation 15°; after 6 months postoperatively increased to: flexion 165°, abduction 165°, external rotation 45°. CONCLUSION. The received results do let us characterize the method of simultaneous shoulder joint arthroscopy and endoscopic brachial plexus decompression in thoracic aperture and interscalene space as a low-traumatic and effective technique, eliminating pain and providing early restoration of shoulder joint and upper extremity function. © Eco-Vector, 2022.