Our Summary

This research paper is about a study conducted on 77 patients with neurogenic thoracic outlet syndrome (nTOS), a condition that causes pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip. The study aimed to evaluate the effectiveness of a treatment called scalene botulinum toxin injection (BTI), both alone and in combination with surgery.

The patients were treated with BTI and their progress was tracked. They found that around 78% of the patients reported feeling better after the BTI treatment, which was confirmed by an improved disability score.

However, about 40% of the patients continued to experience symptoms and went on to have surgery. After having both BTI and surgery, almost 97% of patients reported feeling better, and their disability scores improved significantly.

In simple terms, the study found that BTI can help to lessen symptoms in patients with nTOS. However, combining BTI with surgery was found to give additional symptom relief.

FAQs

  1. What is neurogenic thoracic outlet syndrome (nTOS) and what symptoms does it cause?
  2. What is the effectiveness of scalene botulinum toxin injection (BTI) in treating nTOS according to the study?
  3. How did the combination of BTI and surgery affect the treatment outcome for patients with nTOS in the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about thoracic outlet syndrome surgery is to follow post-operative instructions carefully, including proper wound care, physical therapy exercises, and any restrictions on activities. It is important to give your body time to heal and follow up with your healthcare provider regularly to monitor your progress and address any concerns. Additionally, maintaining good posture and incorporating stretching and strengthening exercises into your daily routine can help prevent recurrence of symptoms.

Suitable For

Patients who are typically recommended thoracic outlet syndrome surgery are those who have not experienced significant improvement with conservative treatments such as physical therapy, medication, and injections. These patients may have persistent and severe symptoms such as chronic pain, numbness, weakness, and muscle atrophy that significantly impact their daily activities and quality of life.

Additionally, patients who have a confirmed diagnosis of neurogenic thoracic outlet syndrome through imaging studies and diagnostic tests may be considered for surgery. These tests may include nerve conduction studies, electromyography, and imaging studies such as MRI or ultrasound to identify compression of the nerves or blood vessels in the thoracic outlet.

Patients who have failed to respond to other treatments and have evidence of nerve compression or vascular abnormalities causing their symptoms may benefit from thoracic outlet syndrome surgery. It is important for patients to undergo a comprehensive evaluation by a multidisciplinary team of healthcare providers, including neurologists, vascular surgeons, and orthopedic surgeons, to determine the most appropriate treatment plan for their individual case.

Timeline

Before surgery:

  1. Patient experiences symptoms such as pain in the neck and shoulder, numbness and tingling in the fingers, and weakness in the grip.
  2. Patient may undergo diagnostic tests such as imaging studies and nerve conduction studies to confirm the diagnosis of thoracic outlet syndrome.
  3. Patient may be treated with conservative measures such as physical therapy, medication, and scalene botulinum toxin injection (BTI) to alleviate symptoms.

After surgery:

  1. Patient undergoes thoracic outlet syndrome surgery, which may involve removing a portion of the first rib, releasing constricting muscles or structures, or repairing damaged nerves.
  2. Patient may experience post-operative pain and discomfort, which can be managed with pain medication.
  3. Patient undergoes rehabilitation and physical therapy to regain strength and function in the affected area.
  4. Patient gradually experiences improvement in symptoms such as reduced pain, improved grip strength, and decreased numbness and tingling.
  5. Patient reports feeling better and experiences a significant improvement in disability scores after combining BTI with surgery.

What to Ask Your Doctor

Here are some questions a patient may consider asking their doctor about thoracic outlet syndrome surgery:

  1. What are the potential risks and complications associated with thoracic outlet syndrome surgery?
  2. How long is the recovery process after thoracic outlet syndrome surgery?
  3. What type of surgery will be performed for thoracic outlet syndrome, and how does it work to alleviate symptoms?
  4. Are there any alternative treatments or therapies that could be considered before opting for surgery?
  5. What is the success rate of thoracic outlet syndrome surgery, and what outcomes can I expect?
  6. Will I need physical therapy or rehabilitation after thoracic outlet syndrome surgery?
  7. How long will it take for me to see improvement in my symptoms after undergoing surgery?
  8. Are there any restrictions or lifestyle changes I will need to make following thoracic outlet syndrome surgery?
  9. How long do the effects of thoracic outlet syndrome surgery typically last?
  10. What is the likelihood of the condition recurring after undergoing surgery for thoracic outlet syndrome?

Reference

Authors: Fereydooni A, Ho VT, Olson EM, Dyrek P, Harris T, Kussman A, Roh E, Lee JT. Journal: Clin J Sport Med. 2023 Mar 1;33(2):116-122. doi: 10.1097/JSM.0000000000001094. Epub 2022 Nov 11. PMID: 36367782