Diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome is excellent.
BACKGROUND
The purpose of this study was to categorize patients referred to a specialized thoracic outlet syndrome (TOS) practice to determine the diagnostic accuracy of those who are physician and self-referred.


METHODS
Demographic and clinical data on all patients who were referred for TOS between 2006 and 2010 were retrospectively reviewed from a prospectively maintained institutional review board-approved database and patient records.


RESULTS
Between 2006 and 2010, 621 patients were referred for TOS (433 women and 188 men; mean age 39 years [range 10-87]). Five hundred seventy-one patients (92%) were diagnosed with TOS, with 421 (74%) neurogenic, 126 (22%) venous, and 24 (4%) arterial TOS cases. Of the 525 physician referrals, 478 (91%) had TOS, and of the 93 self-referrals, 90 (97%) had TOS. The 421 patients with neurogenic TOS (NTOS, 304 women and 117 men) had symptoms on average for 56 months (range 1-516). Two hundred seventy-one patients (64%) were initially treated with TOS-specific physical therapy (PT), and 100 (37%) improved. One hundred seventy-eight patients (42%) underwent a lidocaine block, and 145 patients (81%) had a positive block. Seventy-four patients (18%) underwent Botox injections 44 (60%) of which were positive and the average number of Botox injections was 1.3. One hundred forty patients (33%) underwent transaxillary first rib resection and scalenectomy (FRRS), and 128 patients (91%) improved. Of patients undergoing FRRS, 92 (66%) had a lidocaine block, 82 (89%) of which were positive. Of patients with a positive lidocaine block, 74 (90%) improved after FRRS. Of patients undergoing FRRS, 31 (22%) underwent Botox injections, 15 (48%) of which were positive. Of patients with a positive Botox block, 14 (93%) improved after FRRS. Average length of time between initial visit and operation was 6.4 months (range 2 weeks to 34 months), and average follow-up time was 13 months (range 1 week to 49 months).


CONCLUSIONS
1) Both referring physicians and patients are very accurate in their preliminary diagnosis of TOS (neurogenic, venous, or arterial TOS). 2) In a specialized TOS practice, two-thirds of patients are sent to TOS-specific PT and one-third improve from this treatment alone. 3) One-third of patients referred for NTOS eventually undergo FRRS with a 91% success rate.
Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: klikes1@jhmi.edu.
Kendall
K
Likes
Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
Danielle H
DH
Rochlin
Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
Quinn
Q
Salditch
Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
Thadeus
T
Dapash
Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
Yen
Y
Baker
Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
Roxanne
R
DeGuzman
Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
Shalini
S
Selvarajah
Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
Julie Ann
JA
Freischlag
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002983:Clinical Competence; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D018584:Physician Self-Referral; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis*; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*; D055815:Young Adult