Our Summary

This study looked at a rare form of a condition called neurogenic thoracic outlet syndrome (TOS), which affects the nerves in the upper chest. Patients with this condition may experience muscle wasting in their hands or a decrease in sensation. The researchers wanted to understand the symptoms, causes, and surgical outcomes of this condition.

They did this by looking at the medical records of 50 patients (47 adults and 3 children, mainly women) who had been diagnosed with this condition between 1994 and 2019. Most had signs of muscle loss, while a few only had reduced sensation. Forty of these patients underwent surgery, often through an approach above the collarbone, while 13 didn’t have surgery because their symptoms weren’t worsening.

The researchers found that, on average, patients reported an 87% improvement after surgery, and their arm function improved from 38% before surgery to 77% afterwards. Despite only moderate objective improvements, patients were generally very satisfied with the results of the surgery. The pain disappeared in many cases, and the condition was stabilized or even partially reversed in some instances.

The study concludes that for those with this rare form of TOS, surgery can be an effective treatment, especially for those with worsening symptoms. An anatomical anomaly (a physical abnormality) is always present in these cases. Despite the modest objective gains, patients often feel a significant improvement in function, leading to high satisfaction rates.

FAQs

  1. What is neurogenic thoracic outlet syndrome (TOS) and what are its symptoms?
  2. What were the findings of the study regarding the surgical treatment of neurogenic thoracic outlet syndrome (TOS)?
  3. What factors contribute to the high satisfaction rates among patients who undergo surgery for neurogenic thoracic outlet syndrome (TOS)?

Doctor’s Tip

A helpful tip a doctor might tell a patient about thoracic outlet syndrome surgery is to follow the post-operative instructions carefully, including any physical therapy or rehabilitation exercises prescribed. It is important to give yourself enough time to heal and avoid any strenuous activities that could worsen your condition. Additionally, be sure to communicate with your healthcare provider about any changes or concerns you may have during the recovery process.

Suitable For

Patients with neurogenic thoracic outlet syndrome who have symptoms such as muscle wasting in the hands or decreased sensation are typically recommended for thoracic outlet syndrome surgery. These patients may also have signs of nerve compression in the upper chest area. Surgery is usually recommended for those with worsening symptoms that are not improving with conservative treatments. Anatomical abnormalities are often present in these cases, which can be addressed through surgical intervention.

Timeline

In summary, the timeline of a patient with neurogenic thoracic outlet syndrome before and after surgery may look like this:

  • Before surgery: Patients may experience symptoms such as muscle wasting in the hands, decreased sensation, and worsening arm function. They may undergo diagnostic tests to confirm the diagnosis of TOS and may try conservative treatments such as physical therapy or medication.

  • Surgery: Patients who undergo surgery typically experience an 87% improvement in symptoms, with arm function improving from 38% to 77%. The surgical approach is often through the area above the collarbone, and the procedure aims to address the anatomical anomaly causing the nerve compression.

  • After surgery: Patients report a significant reduction in pain, stabilization or partial reversal of the condition, and improved arm function. Despite only moderate objective improvements, patients are generally very satisfied with the results of the surgery and may experience a significant improvement in their quality of life.

What to Ask Your Doctor

Some questions a patient should ask their doctor about thoracic outlet syndrome surgery include:

  1. What are the potential risks and complications associated with thoracic outlet syndrome surgery?
  2. How long is the recovery process after surgery, and what can I expect in terms of pain and limitations during this time?
  3. What type of surgical approach will be used for my specific case, and what are the success rates associated with this approach?
  4. Will I need physical therapy or rehabilitation after surgery, and if so, how long will this be necessary?
  5. Are there alternative treatments or therapies available for thoracic outlet syndrome that I should consider before opting for surgery?
  6. How likely is it that my symptoms will improve or be resolved completely after surgery?
  7. Will I need to make any lifestyle changes or modifications after surgery to prevent a recurrence of thoracic outlet syndrome?
  8. How experienced is the surgical team in performing thoracic outlet syndrome surgery, and what is their success rate with this procedure?
  9. Can you provide me with information about other patients who have undergone thoracic outlet syndrome surgery and their outcomes?
  10. What is the long-term prognosis for patients who have undergone surgery for thoracic outlet syndrome?

Reference

Authors: Servasier L, Marteau E, Bacle G, Roulet S, Corcia P, Odent T, Laulan J. Journal: Orthop Traumatol Surg Res. 2022 Sep;108(5):103329. doi: 10.1016/j.otsr.2022.103329. Epub 2022 May 18. PMID: 35597546