title: Thoracic outlet syndrome after motor vehicle accidents in a Canadian pain clinic population.
abstract: OBJECTIVE
  To record symptoms and signs, operative findings, and long-term outcome in operated and nonoperated patients with the diagnosis of thoracic outlet syndrome after a motor vehicle accident.
  
  
  METHODS
  Descriptive prospective study.
  
  
  METHODS
  Pain clinic population in the Toronto Hospital (Western Division), Toronto, Ontario, Canada.
  
  
  METHODS
  Thirty-two patients diagnosed as having thoracic outlet syndrome after injuries sustained in a car accident (based on specific symptoms and signs as well as exclusion of other disorders generating brachialgia).
  
  
  METHODS
  Conservative management versus transaxillary or supraclavicular exploration of the thoracic outlet.
  
  
  METHODS
  Pain/symptom relief.
  
  
  RESULTS
  Most patients presented with pain and paresthesiae, but conspicuous discoloration of the symptomatic extremity was seen in 41%. Osseous anomalies were seen in 22% of the patients in simple neck x-rays. Vascular studies were abnormal in 24% of tested patients. During transaxillary first rib resection in 15 patients, 87% were found to have musculotendinous and less often osseous anomalies compromising primarily the lower trunk of the brachial plexus. Long-term follow up demonstrated very good pain relief (based on patients' estimates) only in 47% of the operated patients and 20% of the conservatively treated patients. Reoperation was necessary in six cases through a supraclavicular decompression with only one patient experiencing substantial improvement with long-term follow-up. The difficulties in diagnosis as well as reasons for failures of conservative and surgical management are discussed, and the authors' current protocol for diagnosis and management is presented.
authors.affiliation: Department of Medicine, Toronto Hospital, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Mailis
authors.forename: M
authors.initials: M
authors.lastname: Papagapiou
authors.forename: R G
authors.initials: RG
authors.lastname: Vanderlinden
authors.forename: V
authors.initials: V
authors.lastname: Campbell
authors.forename: A
authors.initials: A
authors.lastname: Taylor
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D002170:Canada; D002908:Chronic Disease; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D018710:Pain Clinics; D059408:Pain Management; D010292:Paresthesia / Q000209:etiology; D011446:Prospective Studies; D012737:Sex Factors; D013901:Thoracic Outlet Syndrome / Q000209:etiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome