[True neurological thoracic outlet syndrome. Retrospective study of 30 consecutive cases].
OBJECTIVE
Neurologic TOS with amyotrophy is exceptional and the diagnosis is usually delayed compromising the outcome after treatment. The aims of this study were to define clinical features, anatomical causes, surgical results and prognostic factors of this disease.


METHODS
All of the TOS with objective neurologic deficit treated in our unit between 1989 and 2011 were assessed retrospectively. Thirty cases were identified in 28 patients (two bilateral cases). The mean-age was 44 years (16 to 70).


RESULTS
Muscular atrophy always predominated in the lateral thenar muscles. Seventeen also had sensory symptoms. Twenty-two patients (24 cases) were surgically treated. Twenty-three cases could be assessed with a mean follow-up of 39 months. Recovery was complete in four cases (17%), marked in nine cases (39%) and minimal in ten cases (44%).


CONCLUSIONS
Neurological TOS with objective manifestations have to be distinguished from other types of neurological TOS. Muscular atrophy in the hand appears insidiously and the pain, which is inconstant, stays always in the background. Duration of symptoms before surgical treatment is the main prognostic factor.
Services de chirurgie orthopédique et traumatologique 1 et 2, unité de chirurgie de la main, hôpital Trousseau, CHU de Tours, 37044 Tours cedex, France.
F-L
FL
Marty
P
P
Corcia
J
J
Alexandre
J
J
Laulan
D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome