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. 2022 Jan;17(1):43-49.
doi: 10.1177/1558944719901319. Epub 2020 Feb 10.

Intermediate and Long-term Outcomes Following Surgical Decompression of Neurogenic Thoracic Outlet Syndrome in an Adolescent Patient Population

Erin F Ransom  1 , Heather L Minton  2 , Bradley L Young  3 , Jun Kit He  1 , Brent A Ponce  1 , Gerald McGwin  1 , Richard D Meyer  1 , Eugene W Brabston 3rd  1
Affiliations

Intermediate and Long-term Outcomes Following Surgical Decompression of Neurogenic Thoracic Outlet Syndrome in an Adolescent Patient Population

Erin F Ransom et al. Hand (N Y). 2022 Jan.

Abstract

Background: Although the diagnosis of thoracic outlet syndrome (TOS) is often missed, outcomes from surgical intervention significantly improve patient satisfaction. This article seeks to highlight patient characteristics, intraoperative findings, and both short and long-term outcomes of thoracic outlet decompression in the adolescent population. Methods: A retrospective chart review of patients between the ages of 13 and 21 years with a clinical diagnosis of neurogenic thoracic outlet syndrome (NTOS) who were treated surgically between 2000 and 2015 was performed. Data points including preoperative patient characteristics and intraoperative findings were collected. In addition, patient-reported outcome scores, including Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, Cervical Brachial Symptom Questionnaire (CBSQ), and NTOS index, were obtained for a cohort of patients with follow-up ranging from 2 to 15 years. Results: The study population consisted of 54 patients involving 61 extremities. The most common procedures included neurolysis of the supraclavicular brachial plexus (60, 98.4%), anterior scalenectomy (59, 96.7%), and middle scalenectomy (54, 88.5%). First rib resection (FRR) was performed in 28 patients (45.9%). Long-term outcomes were collected for 24 (44%) of 54 patients with an average follow-up of 69.5 months (range, 24-180 months). The average VAS improved from 7.5 preoperatively to 1.8 postoperatively. The average SANE increased from 28.9 preoperatively to 85.4 postoperatively. The average postoperative scores were 11.4 for the QuickDASH, 27.4 for the CBSQ, and 17.2 for the NTOS index. Subgroup analysis of patients having FRR (28, 45.9%) demonstrated no difference in clinical outcome measures compared with patients who did not have FRR. Conclusion: Surgical treatment of NTOS in adolescent patients has favorable intermediate and long-term outcomes.

Keywords: brachial plexus; diagnosis; nerve; nerve compression; pain; pediatric; specialty; surgery; thoracic outlet syndrome.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: B.A.P. reports personal fees from Tornier/Wright Medical and Help Lightening, outside the submitted work. R.D.M. reports personal fees from Nutech Medical, outside the submitted work. All other authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
A fibrous band constricting the plexus on the posterior border. Note. Anterior and middle scalene have already been resected at this point. This is a left-sided operation, and the medial aspect of the patient is on the left side of the figure. The arrow is pointing to the fibrous band held within the forceps after it has been pulled away from the brachial plexus.
Figure 2.
Figure 2.
The coracocostal ligament is visible on the posterior aspect of the coracoid aiming medially. This is the left side of a patient with medial on the left side of the figure and lateral on the right side of the figure. Note. The arrow is pointing to the fibrous band held within the forceps after it has been pulled away from the brachial plexus.
See this image and copyright information in PMC

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