Our Summary

Thoracic Outlet Syndrome (TOS) is a disorder that involves pain, tingling, or numbness caused by pressure on the nerves or blood vessels in the neck and shoulder area. This paper looks at the causes, diagnosis, and treatment options for TOS. The syndrome is categorized into three main types: vascular TOS, neurogenic TOS, and a mix of both. Neurogenic TOS, which involves nerve compression, is the most common type, making up over 90% of all cases.

Diagnosing TOS can be challenging due to its varying symptoms. Beyond non-surgical treatments, surgical methods aimed at relieving pressure on the nerves and blood vessels have been found to improve symptoms in up to 92% of cases. The surgery is usually performed from either above the collarbone or through the armpit, and can provide long-term benefits for 50 to 80% of patients.

Though serious complications from surgery are rare (0-2%), minor complications such as collapsed lung, bleeding, or leakage of lymph fluid can occur in up to 25% of cases.

Overall, the study confirms that most TOS patients can benefit from surgical treatment. However, the success of the treatment depends on the duration of symptoms, socioeconomic factors, and most importantly, a thorough diagnosis and appropriate surgical procedure carried out by an experienced medical team.

FAQs

  1. What is Thoracic Outlet Syndrome (TOS) and what are the different types of TOS?
  2. What are the success rates and potential complications of surgery for TOS?
  3. What factors influence the success of surgical treatment for TOS?

Doctor’s Tip

A helpful tip a doctor might give a patient about thoracic outlet syndrome surgery is to follow post-operative care instructions carefully to ensure proper healing and minimize the risk of complications. This may include physical therapy, avoiding heavy lifting or strenuous activities, and attending follow-up appointments with your healthcare provider. Make sure to communicate any concerns or changes in symptoms to your doctor promptly.

Suitable For

Patients who are typically recommended for thoracic outlet syndrome surgery are those who have tried non-surgical treatments but have not found relief from their symptoms. These patients may be experiencing severe pain, numbness, tingling, weakness, or other symptoms that significantly impact their daily life and functioning. Additionally, patients with a confirmed diagnosis of TOS, either through imaging tests or physical examination, are good candidates for surgical intervention.

It is important for patients to undergo a thorough evaluation by a medical professional to determine the appropriate course of treatment. Factors such as the type of TOS, the severity of symptoms, the duration of symptoms, and the overall health of the patient will all be taken into consideration when recommending surgery.

Overall, patients who are experiencing persistent and debilitating symptoms of thoracic outlet syndrome despite conservative treatments may benefit from surgery to relieve pressure on the affected nerves and blood vessels. It is essential for patients to discuss the risks and benefits of surgery with their healthcare provider and to choose a skilled and experienced surgical team to ensure the best possible outcome.

Timeline

Timeline of what a patient experiences before and after thoracic outlet syndrome surgery:

Before surgery:

  1. Patient experiences symptoms such as pain, tingling, or numbness in the neck and shoulder area.
  2. Patient undergoes diagnostic tests such as imaging studies and nerve conduction studies to confirm the diagnosis of TOS.
  3. Non-surgical treatments such as physical therapy, medications, and lifestyle modifications are attempted to relieve symptoms.
  4. If symptoms persist, surgery may be recommended as a last resort option.

After surgery:

  1. Patient undergoes thoracic outlet syndrome surgery, which is performed from either above the collarbone or through the armpit.
  2. Patient may experience minor complications such as collapsed lung, bleeding, or leakage of lymph fluid in up to 25% of cases.
  3. Most patients experience improvement in symptoms post-surgery, with up to 92% of cases showing relief.
  4. Long-term benefits are seen in 50 to 80% of patients who undergo surgery.
  5. Serious complications from surgery are rare, occurring in 0-2% of cases.
  6. Success of the treatment depends on the duration of symptoms, socioeconomic factors, and the skill of the medical team performing the surgery.

What to Ask Your Doctor

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

  1. What type of thoracic outlet syndrome do I have (vascular, neurogenic, or a mix of both)?
  2. What are the potential risks and complications associated with thoracic outlet syndrome surgery?
  3. How long is the recovery process after thoracic outlet syndrome surgery?
  4. What are the success rates of thoracic outlet syndrome surgery in relieving symptoms?
  5. Will I need physical therapy or rehabilitation after thoracic outlet syndrome surgery?
  6. How experienced is the surgical team in performing thoracic outlet syndrome surgeries?
  7. Are there any alternative treatment options to surgery for thoracic outlet syndrome?
  8. How long have I been experiencing symptoms of thoracic outlet syndrome, and will this impact the effectiveness of surgery?
  9. What can I expect in terms of pain management after thoracic outlet syndrome surgery?
  10. How soon after surgery can I expect to see improvements in my symptoms related to thoracic outlet syndrome?

Reference

Authors: Seifert S, Sebesta P, Klenske M, Esche M. Journal: Zentralbl Chir. 2017 Feb;142(1):104-112. doi: 10.1055/s-0042-121611. Epub 2017 Mar 16. PMID: 28303559