Our Summary

This research paper looks at the results of a surgery called brachial plexus decompression in patients with a condition called neurogenic thoracic outlet syndrome (N-TOS). In simple terms, N-TOS is a disorder that involves pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip. The brachial plexus is a network of nerves that sends signals from your spinal cord to your shoulder, arm and hand.

The surgery, which involves removing fibrous tissue that’s pressing on these nerves and sometimes also removing abnormal bone growth, was performed on 17 patients between 2013 and 2021. The researchers then observed these patients for up to 4 years after the surgery, looking at things like pain levels, numbness and tingling, and hand strength, as well as patients’ own reports of their symptoms.

The results showed that the surgery was safe and generally effective in relieving pain and numbness/tingling. All patients reported improvement in their symptoms. However, the surgery did not seem to improve hand strength in patients who had noticeable physical signs of N-TOS. The researchers concluded that while the surgery can help with symptoms related to irritation of the lower trunk nerves, it doesn’t seem to help with hand muscle recovery in patients with physical signs of N-TOS.

FAQs

  1. What is neurogenic thoracic outlet syndrome (N-TOS) and how does it affect patients?
  2. What is the purpose of brachial plexus decompression surgery in treating N-TOS?
  3. Did the surgery improve hand strength in patients with noticeable physical signs of N-TOS according to the research?

Doctor’s Tip

One helpful tip a doctor might give a patient about thoracic outlet syndrome surgery is to follow a comprehensive rehabilitation program post-surgery to maximize recovery. This may include physical therapy exercises to improve strength and range of motion, as well as ergonomic modifications to prevent future strain on the affected nerves. It’s important to communicate with your healthcare team throughout the recovery process to address any concerns or changes in symptoms.

Suitable For

Patients who are typically recommended thoracic outlet syndrome surgery are those who have been diagnosed with neurogenic thoracic outlet syndrome (N-TOS) and have not responded well to conservative treatments such as physical therapy, medication, and nerve blocks. These patients may experience severe pain in the neck and shoulder, numbness and tingling in the fingers, and weakness in the hand and arm. They may also have physical signs of N-TOS, such as muscle wasting or weakness in the hand.

It is important for patients to undergo a comprehensive evaluation by a healthcare provider specializing in thoracic outlet syndrome to determine if surgery is the best course of action. This evaluation may include imaging tests such as MRI or ultrasound to confirm the diagnosis and assess the extent of nerve compression.

Overall, patients who are recommended thoracic outlet syndrome surgery are those who have persistent and debilitating symptoms that significantly impact their quality of life and daily activities. Surgery may be considered as a last resort when conservative treatments have not provided adequate relief.

Timeline

Before the surgery:

  1. Patient experiences symptoms such as neck and shoulder pain, numbness and tingling in the fingers, and weak grip.
  2. Patient undergoes diagnostic tests such as physical examination, electromyography, and imaging studies to confirm the diagnosis of N-TOS.
  3. Patient undergoes conservative treatments such as physical therapy, pain medication, and lifestyle modifications to manage symptoms.
  4. If conservative treatments are unsuccessful, the patient may be recommended for brachial plexus decompression surgery.

After the surgery:

  1. Patient undergoes brachial plexus decompression surgery, which involves removing fibrous tissue and sometimes abnormal bone growth pressing on the nerves.
  2. Patient is monitored post-surgery for pain levels, numbness and tingling, hand strength, and overall symptom improvement.
  3. Patients generally report improvement in their symptoms, with relief from pain and numbness/tingling.
  4. However, hand strength may not improve in patients with physical signs of N-TOS, indicating that the surgery may not help with muscle recovery in these cases.
  5. Patients are followed up for up to 4 years after surgery to assess long-term outcomes and symptom management.

What to Ask Your Doctor

  1. What specific symptoms indicate that I may have thoracic outlet syndrome?
  2. How do you determine if surgery is necessary for my thoracic outlet syndrome?
  3. What are the potential risks and complications of thoracic outlet syndrome surgery?
  4. What is the success rate of thoracic outlet syndrome surgery in relieving symptoms?
  5. What is the recovery process like after thoracic outlet syndrome surgery?
  6. How soon after surgery can I expect to see improvement in my symptoms?
  7. Will I need physical therapy or other treatments after thoracic outlet syndrome surgery?
  8. Are there any long-term effects or considerations to be aware of after thoracic outlet syndrome surgery?
  9. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  10. How many thoracic outlet syndrome surgeries have you performed, and what is your experience with this procedure?

Reference

Authors: Diner C, Mathieu L, Vandendries C, Oberlin C, Belkheyar Z. Journal: Hand Surg Rehabil. 2023 Feb;42(1):9-14. doi: 10.1016/j.hansur.2022.11.009. Epub 2022 Nov 26. PMID: 36574580