Our Summary

Thoracic outlet syndrome (TOS) is a condition where the nerves and blood vessels in the neck and chest area get squashed, causing pain and discomfort. The first step in treatment is usually non-surgical methods, but if these don’t work, surgery may be necessary. In this study, the researchers looked at the results of surgeries they had carried out on children with TOS over a 19-year period. They treated nine patients, whose ages ranged from 7 to 17 years old. Most of the surgeries were done through the underarm area, but two were done through the collarbone area. Only one minor problem occurred during surgery, and there were no issues after surgery. The children were in the hospital for 2-4 days on average. Two of them later had symptoms on the other side of their body, and one had another successful surgery. At follow-ups ranging from 4 months to 20 years after the surgery, all the patients were symptom-free. Based on these results, the authors believe that this type of surgery is a safe and effective method for treating children with TOS that doesn’t improve with non-surgical treatments.

FAQs

  1. What is Thoracic Outlet Syndrome (TOS) and how is it usually treated?
  2. What was the success rate of thoracic outlet syndrome surgeries in children, according to this study?
  3. How long did the children who underwent TOS surgery typically stay in the hospital?

Doctor’s Tip

One important tip that a doctor might give a patient about thoracic outlet syndrome surgery is to follow all pre-operative instructions carefully. This may include fasting before the surgery, stopping certain medications, and avoiding smoking or alcohol. It is also important to discuss any concerns or questions with the surgical team before the procedure. After surgery, following post-operative care instructions, such as taking prescribed medications, attending follow-up appointments, and participating in physical therapy, is crucial for a successful recovery. Additionally, patients should be aware of potential complications and notify their doctor immediately if they experience any unusual symptoms or side effects.

Suitable For

Patients who are typically recommended for thoracic outlet syndrome surgery are those who have not seen improvement with non-surgical treatments such as physical therapy, medication, and lifestyle changes. Surgery is usually considered when the symptoms of TOS are severe and significantly impact the patient’s quality of life, such as persistent pain, weakness, and numbness in the arm and hand. Additionally, patients who have compression of blood vessels leading to circulation issues or nerve compression leading to muscle wasting may also be recommended for surgery. The decision to undergo surgery is made on a case-by-case basis after thorough evaluation by a medical professional.

Timeline

  • Before surgery: Patients may experience symptoms such as pain, numbness, weakness, or swelling in the neck, shoulder, arm, or hand. They may also have trouble with certain movements or activities. Non-surgical treatments such as physical therapy, medication, or nerve blocks may be attempted to alleviate symptoms.

  • Surgery: If non-surgical treatments are ineffective, surgery may be recommended. The surgery is typically performed through the underarm or collarbone area to release the compressed nerves and blood vessels. The procedure usually lasts a few hours, and patients are typically in the hospital for 2-4 days.

  • After surgery: Patients may experience some pain, swelling, or discomfort at the surgical site, which can be managed with pain medication. Physical therapy may be recommended to help regain strength and range of motion in the affected arm. Follow-up appointments will be scheduled to monitor progress and address any concerns. In the study mentioned, all patients were symptom-free at follow-ups ranging from 4 months to 20 years after surgery.

Overall, thoracic outlet syndrome surgery can be a safe and effective treatment option for patients who do not respond to non-surgical treatments. With proper care and follow-up, patients can experience significant improvement in their symptoms and quality of life.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with thoracic outlet syndrome surgery?

  2. How long is the recovery period after surgery and what can I expect in terms of pain and limitations during this time?

  3. Will I need physical therapy or rehabilitation after surgery to regain strength and mobility?

  4. How successful is surgery in relieving symptoms of thoracic outlet syndrome in the long term?

  5. Are there any alternative treatment options to surgery that I should consider before moving forward with the procedure?

  6. How many surgeries have you performed for thoracic outlet syndrome and what is your success rate?

  7. Will I need to make any lifestyle changes or modifications after surgery to prevent a recurrence of symptoms?

  8. What can I do to prepare for surgery and optimize my recovery outcome?

  9. Are there any specific exercises or activities that I should avoid after surgery to prevent complications?

  10. How soon after surgery can I expect to return to my normal daily activities and work?

Reference

Authors: Boglione M, Ortíz R, Teplisky D, Giuseppucci C, Korman L, Reusmann A, Barrenechea M. Journal: J Pediatr Surg. 2022 Sep;57(9):29-33. doi: 10.1016/j.jpedsurg.2021.08.017. Epub 2021 Sep 4. PMID: 34563357