Surgical and Functional Outcomes After Thoracic Outlet Syndrome Decompression via Supraclavicular Approach: A 10-Year Single Centre Experience

Abstract

Background: Thoracic outlet syndrome (TOS) results from compression of the neurovascular structures in the region of thoracic outlet. Treatment depends on the variant (venous, arterial, neurological or any combination of these), severity of symptoms and response to the conservative management. The aim was to assess surgical and functional outcomes after surgical decompression using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Methods: A retrospective review of all TOS cases operated in our department between 2002 and 2012. Collected data provided information on patients’ demographics, TOS type, operative findings, complications and follow-up. The pre and post operative DASH questionnaire scores were recorded. Results: Forty four patients (88%) completed pre and post operative DASH questionnaire. Mean age was 42 ± 10.78 years (range 16 - 60) and 37 were women. Twenty seven patients had the combination of neurological and vascular symptoms. The reminder of patients presented with venous TOS (vTOS, n = 5), arterial TOS (aTOS, n = 7) and 3 cases with venous-arterial TOS. There were 40 elective and 4 emergency operations. All operations were performed under the general anaesthesia and via supraclavicular approach. Decompressive procedures consisted of an excision of the cervical (n = 11) or first rib (n = 23), combined cervical and first rib excision (n = 10), scalenectomy (n = 42) and division of soft tissue (n = 24). Post operative complications included wound infection (n = 1), phrenic nerve traction injury (n = 2) and pleural entries (n = 12). There were no brachial plexus or vascular injuries. Mean follow up was 11.7 ± 15.4 months. Mean DASH questionnaire scores improved post operatively across all TOS groups. When DASH scores were analysed according to the TOS type, the most marked post operative improvement was noted in aTOS with mean delta change of 36.99 ± 22.72, followed by vTOS (26.22 ± 16.89) and nTOS (18.64 ± 21.07). These findings were statistically significant with P < 0.05. Thirty nine (78%) patients reported the return of upper limb function. Only 5 patients (nTOS) reported worsening of the limb function. Conclusions: Careful selection of patients with meticulous surgical technique can produce excellent surgical and functional outcomes in all TOS types. doi: http://dx.doi.org/10.4021/jcs152w