title: Long-term functional results for the surgical management of neurogenic thoracic outlet syndrome.
abstract: 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.
authors.affiliation: Dartmouth-Hitchcock Medical Center, Section of Vascular Surgery, Lebanon, NH 03756, USA.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Scali
authors.forename: David
authors.initials: D
authors.lastname: Stone
authors.forename: Aja
authors.initials: A
authors.lastname: Bjerke
authors.forename: Catherine
authors.initials: C
authors.lastname: Chang
authors.forename: Eva
authors.initials: E
authors.lastname: Rzucidlo
authors.forename: Phillip
authors.initials: P
authors.lastname: Goodney
authors.forename: Daniel
authors.initials: D
authors.lastname: Walsh
mesh_terms: 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
chemical_list: D009294:Narcotics