Long-term functional results for the surgical management of neurogenic thoracic outlet syndrome.
OBJECTIVE
To document long-term functional outcomes in patients treated for neurogenic thoracic outlet syndrome (NTOS).


METHODS
Records of all patients undergoing treatment for NTOS at our center were reviewed. Patient demographics and co-morbidities were recorded. End-points included symptomatic relief, peri-operative adjunctive procedures, functional outcome and employment continuity.


RESULTS
From 1988-2008, 26 patients were operated upon for NTOS. Hallmarks of the diagnosis in operated patients included symptom duration less than 1 year and a positive Roos test. Patients receiving disability and those with cervical spine pathology or carpal tunnel syndrome were not considered for surgery. Mean patient age was 39.2 years (range 14-60 years) with a mean follow-up of 104.4 months. Eleven patients (42.3%) engaged in pre-operative physical therapy programs. 7 of 9 patients (26.9%) received adjunctive peri-procedural scalene block with temporary symptom relief. All patients underwent thoracic outlet decompression by either 1st rib resection [18 total: 8 (44%) transaxillary and 10 (66%) supraclavicular)], cervical rib resection [6 (26.1%)] and/or scalenectomy [12 (46.2%)]. Of the 22 patients available for follow-up, six patients (27.3%) have required continued post-operative narcotic analgesics. Sixteen patients (72.7%) returned to work and reported being at an equivalent or better functional outcome than their pre-operative status.


CONCLUSIONS
Durable long-term functional outcomes can be achieved predicated on a highly selective approach to the surgical management of patients with NTOS. A majority of operated patients will not require adjunctive procedures or chronic narcotic utilization. Patients who undergo surgery can expect to return to work with little or no functional impairment.
Scali
Salvatore
S
Dartmouth-Hitchcock Medical Center, Section of Vascular Surgery, Lebanon, NH 03756, USA.
Stone
David
D
Bjerke
Aja
A
Chang
Catherine
C
Rzucidlo
Eva
E
Goodney
Phillip
P
Walsh
Daniel
D
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D019299:Decompression, Surgical; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D009407:Nerve Block; D009513:New Hampshire; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D009294:Narcotics