Surgery for suspected neurogenic thoracic outlet syndromes: a follow up study
Michael Donaghya, Zelko Matkovica, Peter Morrisb
a Department of
Clinical Neurology, b Nuffield Department of Surgery, University of
Oxford, Radcliffe Infirmary and John Radcliffe Hospital, Oxford, UK
Correspondence to: Dr Michael Donaghy. Department of Clinical Neurology, Radcliffe Infirmary, Oxford OX2 6HE, UK. Telephone 0044 1865 224698; fax 0044 1865 790493.
Received 29 June 1998 and in revised form 18 June 1999;
Accepted 29 June 1999
OBJECTIVES
To assess
the outcome of surgical treatment for thoracic outlet syndrome (TOS),
and to compare the outcome in patients with and without an underlying
cervical rib.
METHODSa
heterogeneous group of 40 patients (33 women, seven men; aged 22-62
years) were evaluated 3 months to 20 years after surgery for suspected
neurogenic TOS. Forty nine operations had been performed: cervical ribs
were removed in 23 patients, together with fibrous band excision in
nine. In the 17 without a cervical rib the thoracic outlet was
decompressed by resection of the first thoracic rib in nine, and by
other operations in eight.
RESULTSAfter
surgery patients reported improved pain (33/36), sensory disturbance
(30/35), hand muscle strength (14/27), and hand function (23/34).
Postoperatively TOS recurred in two, and symptoms continued to
progress in three patients in whom other diagnoses eventually emerged.
Surgical complications were recorded in 10 patients, but were transient
and did not result in permanent symptomatic sequelae.
CONCLUSIONSSurgical
treatment of suspected neurogenic TOS relieves pain and sensory
disturbance (90%), but is less effective for muscle weakness (50%).
Surprisingly, surgery relieved sensory and motor abnormalities to a
similar degree in patients both with and without a cervical rib.
Ideally, patients require early operation to forestall permanent hand
muscle denervation, but, our retrospective analysis fails to identify
any single preoperative diagnostic criterion for TOS, particularly in
patients lacking a radiographic cervical rib.
Keywords: cervical rib; thoracic outlet; surgery
© 1999 by Journal of Neurology, Neurosurgery, and Psychiatry
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