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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Harold C. Urschel, Jr Maruf A. Razzuk Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Urschel, H. C. Articles by Razzuk, M. A. Search for Related Content PubMed Articles by Urschel, H. C., Jr Articles by Razzuk, M. A. Related Collections Related Article

Ann Thorac Surg 2000;69:665
© 2000 The Society of Thoracic Surgeons

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Correspondence

Reply

^a 1201 Barnett Tower, 3600 Gaston Ave, Dallas, TX 75246, USA

e-mail: urschell{at}airmail.net

To the Editor

Several letters have discussed the relationship between C7 and the muscles of the thumb. We are thoracic surgeons and do not perform electromyography or nerve conduction velocity (NCV) studies. Our patients are tested in several different physical medicine laboratories, and the results are reported to us. In answering these letters concerning our scientific report [1], we are providing observations from the physicians who actually performed the tests.

It is also important to recognize that our study [1] was involved primarily with clinical symptoms and signs relating to thoracic outlet syndrome. The terms upper and lower parts of the brachial plexus were used as defined by Swank and Simeone [2]. Because NCV studies were done on most of the patients, these data were included as corroborative information, not as primary clinical determinants.

Although we do not do the electromyography or NCV studies ourselves, allegedly the area stimulated for the upper plexus would presumably include C7, and allegedly the response was evidently measured in the thumb, in either the opponens or adductor muscles as well as other areas. The question raised by the letters suggests doubt that C7 ever supplies these muscles in the thumb.

In addition to the two references [3, 4] that attribute C7 as innervating the opponens or adductor muscles to the thumb, several other observations support the fact that C7 may innervate these muscles. When the C7 nerve root is stimulated at operation, the opponens muscle, the adductor muscle, or both not only record an impulse but frequently contract. After resection of superior pulmonary sulcus carcinomas (more than 500 such operations have been performed in our clinic) where C8 and T1 nerve roots are cut intentionally, the opponens and adductor thenar muscles frequently are not affected with atrophy. In some instances where C7 has been involved in a cervical disc, atrophy of the opponens or adductor muscle of the thumb has been observed (Ron Hoffman, MD: personal communication, Carlsbad, NM).

Even though we do not perform the NCV studies or electromyography, we do see the patients independently, and over 30 years, we have correlated the symptoms of what Swank and Simeone [2] designated as upper and lower plexus symptoms with NCV tests. As previously stated, these correlated very well in the diagnosis and the management of patients treated conservatively or with surgical intervention. Because of this, the data were included.

The techniques for performing the NCV studies have been described [5]. The clinical results after conservative management or operation have been reported.

I recognize the expertise of the writers of the letters, and no doubt they have a basis for their opinions. On the other hand, so do we.

References

1. Urschel H.C., Jr, Razzuk M.A. Upper plexus thoracic outlet syndrome. Ann Thorac Surg 1997;63:935-939.[Abstract/Free Full Text]
2. Swank R.L., Simeone F.A. The scalenus anticus syndrome. Arch Neurol Psychiatry 1944;51:432-450.
3. Gray’s anatomy. 28th American ed. Philadelphia: Lea & Febiger, 1966:753.
4. Morris’ human anatomy. 12th ed. New York: McGraw-Hill, 1966.
5. Caldwell J.W., Crane C.R., Krusen E.M. Nerve conduction studies in the diagnosis of the thoracic outlet syndrome. South Med J 1971;64:210-221.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Harold C. Urschel, Jr Maruf A. Razzuk Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Urschel, H. C. Articles by Razzuk, M. A. Search for Related Content PubMed Articles by Urschel, H. C., Jr Articles by Razzuk, M. A. Related Collections Related Article