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Pain and Spine Medicine

Neurogenic Thoracic Outlet Syndrome Secondary to Surgical Intervention for Lung Cancer, Managed with Scapulothoracic Fusion: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Has Audio

    Poster Presenter(s)

  • Thomas Chai, MD

    Associate Professor, Pain Medicine
    University of TX MD Anderson Cancer Cent
    Missouri City, Texas

    • Co-Author(s)

  • VB

    Vishal Bansal, MD

    Fellow Physician
    University of Texas MD Anderson Cancer Center
    Houston, Texas

    • Primary Author(s)

  • Sara Nalli, BA

    Medical Student, MD Candidate
    St George's University School of Medicine
    Missouri City, Texas

    • Co-Author(s)

  • LD

    Larry C. Driver, MD

    Professor
    The University of Texas MD Anderson Cancer Center
    Houston, Texas

Disclosure(s):
Thomas Chai, MD: No financial relationships to disclose
Sara Nalli, BA: No financial relationships to disclose
Case Diagnosis: 60 year old female with oncologic history of lung cancer, s/p treatment to include extensive surgical intervention for tumor removal, diagnosed with postoperative neurogenic thoracic outlet syndrome.

Case Description or Program Description: Patient underwent anterior transmanubrial approach with partial sternotomy / anterior thoracotomy, R phrenic neurolysis, extended posterolateral thoracotomy with RUL lobectomy and en bloc resection of ribs 1- 4 with azygous flap coverage of the bronchial stump and neurolysis of the brachial plexus.
Subsequently, imaging showed dislocated R clavicle, for which she underwent medial claviculectomy.
Patient experienced ongoing pain in the R chest and arm, which was managed with opioids and adjuvants.
Due to ongoing/worsening pain and paresthesias, she presented to Orthopedics and was diagnosed with neurogenic Thoracic Outlet Syndrome (TOS) secondary to R scapular and forequarter collapse. Patient underwent R scapulothoracic arthrodesis with posterior iliac crest autograft, which improved her pain, scapulothoracic relationship statically/dynamically, and arm function.

Setting: cancer hospital

Assessment/Results: Patient’s pain and functional capacity from TOS improved substantially after R scapulothoracic arthrodesis and intensive physical therapy.

Discussion (relevance): TOS is a condition arising from compression of the neurovascular bundle in the confined space above the first rib and behind the clavicle - the thoracic outlet. Most cases of TOS are neurogenic versus vascular. Nerves of the brachial plexus or vascular structures in this space, such as the subclavian artery or subclavian vein, can be affected. Common causes of TOS include variant anatomy, such as cervical ribs, muscular anomalies of the scalenes, subclavius, or pectoralis minor, and injury via neck hyperextension or hyperflexion. We describe an uncommon case of neurogenic TOS due to forequarter collapse as sequelae of oncologic surgery for lung cancer.

Conclusions: Although rare, postsurgical neurogenic TOS should be included as a differential for patients presenting with ongoing chest and upper extremity pain and paresthesias after surgical oncologic treatment.