title: Post-traumatic thoracic outlet syndrome.
abstract: BACKGROUND
  To evaluate the clinical presentation, diagnostic and therapeutic management and outcome of 27 cases of post-traumatic thoracic outlet syndrome (PT TOS).
  
  
  METHODS
  Retrospective chart analysis.
  
  
  RESULTS
  Nineteen women and eight men were included in this study. Involvement in a traffic accident was the most common scenario. Fracture of either the first rib or the clavicle was reported in eight patients at the time of injury; in others, the diagnosis was cervical or shoulder soft tissue trauma. Upon presentation at our clinic at a mean 41 months after injury, four patients had bilateral symptoms and 17 reported decreased function of either the arm or hand. Two patients presented with severe lower trunk deficits including one who had received surgical intervention at both the cervical spine and elbow before diagnosis of TOS was made. Sixteen and 15 patients were suffering from some degree of anxiety and/or depression. Upon diagnosis of neurogenic TOS, the two patients with atrophy of the hand musculature were treated surgically. Conservative treatment was applied to all other patients. Six months after presentation to our clinic, nine patients demonstrated a significant improvement. The remainder that reported incapacitating symptoms were offered surgical treatment. Three patients declined the latter. Fifteen patients received surgical treatment via an anterior supraclavicular approach with resection of the anterior scalene muscles. Eleven patients had resection of the middle scalene muscle while five had resection of an osseous structure (partial claviculectomy, C7 transverse process or a cervical rib). The two patients with atrophy of the hand only slightly improved their motor deficit but had a notable relief of symptoms of pain. Postoperative improvement occurred in 80% of surgically treated patients.
  
  
  CONCLUSIONS
  The majority of patients suffering from a post-traumatic TOS present a neurogenic, usually subjective syndrome. Prompt therapeutic management is necessary, addressing both physical and psychological complaints. Most patients are cured or well improved by conservative and/or surgical treatment.
authors.affiliation: Department of Neurosurgery, CHU Liège, Domaine Universitaire du Sart Tilman, Liège, Belgium. a.dubuisson@chu.ulg.ac.be
authors.forename: Annie
authors.initials: A
authors.lastname: Dubuisson
authors.forename: Catherine
authors.initials: C
authors.lastname: Lamotte
authors.forename: Marguerite
authors.initials: M
authors.lastname: Foidart-Dessalle
authors.forename: Minh
authors.initials: M
authors.lastname: Nguyen Khac
authors.forename: Tudor
authors.initials: T
authors.lastname: Racaru
authors.forename: Félix
authors.initials: F
authors.lastname: Scholtes
authors.forename: Bruno
authors.initials: B
authors.lastname: Kaschten
authors.forename: Jacques
authors.initials: J
authors.lastname: Lénelle
authors.forename: Didier
authors.initials: D
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D014947:Wounds and Injuries / Q000150:complications / Q000473:pathology*; D055815:Young Adult