Surgical Treatment for Bilateral Thoracic Outlet Syndrome (TOS)

Abstract

Thoracic outlet syndrome (TOS) is a complex entrapment syndrome of the brachial plexus in the thoracic outlet, specifically at the scalene triangle. Although it presents a controversial topic with regards to nomenclature, symptoms, signs, tests, diagnosis, and treatment, it nevertheless exists as a clinical entity. From 1993 to 2004, 42 highly selected patients were diagnosed with 47 TOS were operated on at Chang Gung Memorial Hospital by the senior author (DCC Chuang). Among them five patients with bilateral TOS underwent surgical intervention on both sides. Routine surgical decompression for TOS, including near total resection of the scalene anterior muscle, first rib and cervical rib if present was performed. All patients achieved a good result with release in symptoms and signs, and an increase in limb or hand muscle strength. Complications due to the operation were minimal. There were no cases of symptoms recurrence during one to ten years of post-operative follow-up. The scalene anterior muscle and dynamic first rib anomalies play an important role in the pathophysiology of TOS. Advances in our understanding, evaluation and diagnosis, and improved surgical technique have lead to more predictable outcome. In conclusion, surgical intervention, even for bilateral TOS, is warranted.