title: Surgical treatment of thoracic outlet syndrome in young adults: single centre experience with minimum three-year follow-up.
abstract: Thoracic outlet syndrome is an often misdiagnosed syndrome which consists of a neurovascular compression at the upper thoracic outlet. The clinical presentation can be variable, ranging from mild symptoms to venous thrombosis and muscle atrophy. Many aetiologies, both congenital and acquired, related either to bony or soft tissue anomalies, have been associated with this syndrome. As a consequence, the diagnosis is often challenging and sometimes it can be obtained only with surgical exploration. Additionally, no specific clinical test is considered diagnostic of thoracic outlet syndrome. However, the recent advances in imaging techniques together with a careful clinical evaluation give the surgeon the chance to recognize the constricting anatomy before surgery in many cases. No standard surgical procedure has been identified; however, in literature the largest series have been treated with transaxillary first rib resection. Here we report our experience in the surgical treatment of this syndrome with a minimum follow-up of three years. Our approach consists of performing a supraclavicular decompression without routine first rib resection. This allows for identifying and removing the constricting anatomy in most cases, with satisfactory results in 96.9% of patients and a low complication rate.
authors.affiliation: Department of Orthopaedics and Traumatology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ciampi
authors.forename: Celeste
authors.initials: C
authors.lastname: Scotti
authors.forename: Simonetta
authors.initials: S
authors.lastname: Gerevini
authors.forename: Francesco
authors.initials: F
authors.lastname: De Cobelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Chiesa
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Fraschini
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Peretti
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D002968:Clavicle / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult