title: Thoracic outlet syndrome: fact or fancy? A review of 409 consecutive patients who underwent operation.
abstract: OBJECTIVE
  From an analysis of patients operated on by a single surgeon between 1973 and 1994 for thoracic outlet syndrome (TOS), to determine what findings are helpful in substantiating this diagnosis and what are the results of decompressive thoracic outlet surgery in the management of TOS.
  
  
  METHODS
  A chart review with emphasis on signs, symptoms and results. A preoperative questionnaire was presented to all patients operated on since 1989. Postoperative follow-up was by interview or telephone.
  
  
  METHODS
  A 560-bed university-affiliated tertiary-care teaching hospital.
  
  
  METHODS
  There were 409 adults; 83% were women and the average age was 36 years. In 95% of patients physiotherapy had been unsuccessful. Patients presented with neurologic type (368 [(90%]), arterial impingement (29 [7%]) and venous obstructive symptoms (12 [3%]). The series included 44 patients with bilateral symptoms and 26 patients with cervical ribs. Some form of litigation or compensation was associated with 177 patients.
  
  
  METHODS
  Transaxillary first rib resection in 380 (93%) patients and supraclavicular thoracic outlet decompression in 29 (7%). In 244 patients there was a follow-up of at least 2 years. These patients constituted the follow-up group.
  
  
  RESULTS
  Preoperatively, in the 368 patients who had neurologic TOS, 99% displayed supraclavicular brachial plexus tenderness and 98% exacerbation of symptoms with arms in the abduction external rotated position. There were eight complications of surgical intervention (1.9%). In the follow-up group, there were no deaths, no subclavian/axillary artery or vein damage and no brachial plexus injury. Seventy-eight percent of the patients with neurologic TOS in this group improved postoperatively; 21% had complete relief, 32% had good relief and 25% had fair relief. Twenty-two percent showed no improvement.
  
  
  CONCLUSIONS
  Signs and symptoms helpful in making the diagnosis of neurologic TOS are supraclavicular tenderness on palpation and exacerbation of symptoms with the arms in the abducted external rotated position. The surgical procedures are safe. Patients with TOS refractory to medical management can benefit from thoracic outlet decompression.
authors.affiliation: Department of Surgery, University of Western Ontario, London.
authors.forename: W G
authors.initials: WG
authors.lastname: Jamieson
authors.forename: B
authors.initials: B
authors.lastname: Chinnick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010173:Palpation; D011795:Surveys and Questionnaires; D013901:Thoracic Outlet Syndrome / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome