A hand surgeon's further experience with thoracic outlet compression syndrome

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Vascular Surgery

Background:

• Thoracic outlet compression syndrome (TOCS) presents with arm and hand pain, numbness, and tingling.
• TOCS is frequently overlooked and misdiagnosed due to subtle objective findings.
• Peripheral nerve compression symptoms are present in 40-50% of TOCS patients.

Purpose of the Study:

• To evaluate the efficacy of a combined surgical approach for TOCS.
• To assess long-term outcomes of transaxillary first rib resection and transcervical scalenectomy for TOCS.

Main Methods:

• A 20-year retrospective review (1989-2009) of patients undergoing combined-approach surgery for TOCS.
• Surgical technique involves transaxillary first rib resection followed by transcervical anterior and middle scalenectomy.
• Patient outcomes were assessed via surveys and follow-up evaluations.

Main Results:

• Over 750 patients underwent the combined procedure between 1989 and 2009.
• In an initial cohort (1989-2002), 95 out of 102 surveyed patients reported symptom improvement.
• Outcomes in the later patient group (since 2003) appear comparable or superior to earlier results.

Conclusions:

• The combined surgical approach provides complete thoracic outlet decompression.
• This procedure demonstrates a high rate of symptom improvement and a low recurrence rate for TOCS.
• The described surgical techniques are effective for managing TOCS.