Thoracic outlet syndrome: a multidisciplinary problem with a perspective for microsurgical management without rib resection
Thoracic outlet syndrome (TOS) refers to a group of complex symptoms in the upper extremity caused by compression of the brachial plexus, subclavian artery and vein. Different surgical approaches were described for the management of TOS. There is, however, no “gold standard” procedure for this complicated and multidisciplinary problem.
This study evaluated the effectiveness of a microsurgical neurovascular decompression in the treatment of TOS.
11 patients suffering from TOS (for 1.3 to 15 years after the beginning of the symptoms) were selected for a treatment of the complex symptoms of pain (diffuse or irradiated to the arm and hand), aching or paresthesia in the neck, shoulder, anterior chest, upper extremity and hand. Four of the 11 patients were suffering from signs of vascular compression. Eight patients showed slow progressive neurological deterioration (distribution of the ulnar nerve) with partial muscle atrophy. Patients underwent a microsurgical treatment using a supraclavicular approach followed by brachial plexus neurolysis, scalenectomy and release of the subclavian artery and vein without rib resection. Postoperative results were classified, using Am. J. Surg. (176: 215–218, 1998) scale (4), as good, fair and poor.
Surgical results were studied, with a follow-up of 24 to 48 months. Prior to surgery, all patients had partial or severe limitation in physical activities. Post-operative follow-up showed that 9 (82%) of the 11 patients returned to normal everyday physical activities with a complete or significant relief of the symptoms (good results). In 2 patients (18%) the pain decreased and the use of medication was reduced (fair results). Eight of the 11 patients returned to full or partial employment. There were no cases of poor results in the study.
Microsurgical neurovascular decompression of TOS without a removal of the cervical or first rib using a supraclavicular approach is an effective treatment method for a relief or complete release from symptoms and allows most patients to return to an active normal life.
- Davies AH, Walton J, Stuart E, Morris PJ (1992) Surgical management of the thoracic outlet compression syndrome. Br 1 Surg 79: 372–377
- Dellon AL (1993) The results of supraclavicular brachial plexus neurolysis (without first rib resection) in management of posttraumatic “thoracic outlet syndrome”. J Reconstr Microsurg 9: 11–17 CrossRef
- Durham JR, Yao JST, Pearce WH et al (1995) Arterial injuries in the thoracic outlet syndrome. 1 Vasc Surg 21: 57–70 CrossRef
- Goff CD, Parent FN, Sato DT, Robinson KD, Gregory RT, Gayle RG et al (1988) A comparison of surgery for neurogenic thoracic outlet syndrome between laborers and nonlaborers. Am J Surg 176: 215–218 CrossRef
- Green RM, McNamare J, Ouriel K (1991) Long-term follow-up after thoracic outlet decompression: an analysis of factors determining outcome. J Vasc Surg 14: 739–746 CrossRef
- Mingoli A, Feldhaus RJ, Farina C, Cavallar N, Sapienza P, Marzo L, Cavallaro A (1995) Long-term outcome after transaxillary approach for thoracic outlet syndrome. Surgery 118: 840–844 CrossRef
- Novak CB (2003) Thoracic outlet syndrome. Clin Plastic Surg 30: 175–188 CrossRef
- Rochkind S, Alon M (2000) Microsurgical management of old injuries of the peripheral nerve and brachial plexus. J Reconstr Microsurg 16: 541–546 CrossRef
- Sanders RJ, Haung C (1991) Review of arterial thoracic outlet syndrome with a report of five new intances. Surg Ginecol Obstet 173: 415–425
- Sanders RJ, Haung CE, Pearce WH (1990) Recurrent thoracic outlet syndrome. J Vasc Surg 12: 390–400 CrossRef
- Sanders RJ, Pearce WH (1989) The treatment of thoracic outlet syndrome: a compression of different operations. J Vasc Surg 10: 626–634 CrossRef
- Sellke FW, Kelly TR (1998) Thoracic outlet syndrome. Am J Surg 154–156
- Sessions RT (1989) Reoperation for thoracic outlet syndrome. J Cardiovasc Surg 30: 434–444
- Urshel HC Jr, Razzuk MA (1986) The failed operation for outlet syndrome: the difficulty of diagnosis and management. Thorac Surg 42: 523–528 CrossRef
- Thoracic outlet syndrome: a multidisciplinary problem with a perspective for microsurgical management without rib resection
- Book Title
- How to Improve the Results of Peripheral Nerve Surgery
- pp 145-147
- Print ISBN
- Online ISBN
- Series Title
- Acta Neurochirurgica Supplementum
- Series Volume
- Series ISSN
- Springer Vienna
- Copyright Holder
- Additional Links
- Thoracic outlet syndrome
- Industry Sectors
- eBook Packages
- Editor Affiliations
- 1. Wiener Privatklinik
- Author Affiliations
- 2. Tel Aviv Sourasky Medical Center, Division of Peripheral Nerve Reconstruction, Tel Aviv University, Tel Aviv, Israel
- 3. Tel Aviv Sourasky Medical Center, Department of Neurosurgery, Tel Aviv University, Tel Aviv, Israel
- 5. Tel Aviv Sourasky Medical Center, Department of Radiology, Tel Aviv University, Tel Aviv, Israel
- 6. Tel Aviv Sourasky Medical Center, Department of Vascular Surgery, Tel Aviv University, Tel Aviv, Israel
- 4. Tel Aviv Sourasky Medical Center, Department of Rehabilitation, Tel Aviv University, Tel Aviv, Israel
To view the rest of this content please follow the download PDF link above.