The Surgical Outcome of Thoracic Outlet Syndrome

Hwang, Jung Joo; Joung, Eun Kyu; Paik, Hyo Chae; Lee, Doo Yun

Abstract

BACKGROUND: Thoracic outlet syndrome(TOS) is caused by the compression of neurovascular structures that supply to the upper extremities. Only a few reports have been published in Korea, and this study attempts to investigate the clinical aspects and results of the patients who underwent surgical treatment. MATERIAL AND METHOD: This study consist of 16 patients who underwent operations for thoracic outlet syndrome from May, 2002 to October, 2004. The surgical indications were confined to patients with: 1) symptoms too severe to perform ordinary daily life because of pain, paresthesia, edema of upper extremities, 2) no improvement after proper physical therapy, 3) definite findings of compression confined by radiologic examinations (MRI, angiography, etc), and 4) no other diseases such as cervical intervertebral herniation, myositis, neurologic diseases below the brachial plexus. The surgical approaches were by transaxillary approaches in 12 cases, supraclavicular approaches in 2 cases, and infraclavicular approaches in 2 cases. RESULT: There were 15 males and one female with an average age of 23.9 years (range: 19~39). Rib anomalies were observed in four cases (25.0%), but the others had no abnormal ribs. Right lesions were found in eight cases (50.0%), left lesions in five cases (31.3%), and bilateral lesions in three cases (18.7%). The follow-up period was 9~26 months and recurrence rate was 12.5% (2/16). Complications were one case of ulnar nerve palsy, one case of persistent pain despite radiologic improvement and three cases of wound dehiscence due to fat necrosis and hematoma.
CONCLUSION
Although the choice of treatment in patients with TOS has been disputed, patients who have no response with proper physical therapies can benefit from the surgical treatment which may help patients to return to normal daily activity in shorter period of time.