Surgery for suspected neurogenic thoracic outlet syndromes: a follow up study

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. METHODS a 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. RESULTS After 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. CONCLUSIONS Surgical 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.