Supraclavicular Thoracic Outlet Decompression in the High-Performance Military Population

Area of Science:

• Orthopedics
• Neurosurgery
• Military Medicine

Background:

• Neurogenic thoracic outlet syndrome (nTOS) is prevalent in young, active individuals, including military personnel undergoing intense training.
• Military service members are at risk for nTOS due to demanding physical requirements.

Purpose of the Study:

• To assess functional recovery and return-to-duty status in active duty military patients after supraclavicular thoracic outlet decompression.
• Evaluate the efficacy of partial first rib resection, partial anterior scalenectomy, and brachial plexus neurolysis for nTOS in this population.

Main Methods:

• Retrospective study approved by Walter Reed National Military Medical Center's Institutional Review Board.
• Utilized an institutional database to identify patients undergoing supraclavicular thoracic outlet decompression (Jan 2011-May 2015).
• Collected pre- and post-operative data using the Disabilities of the Arm, Shoulder, and Hand (DASH) survey and the Cervical Brachial Symptoms Questionnaire (CBSQ).

Main Results:

• 85% of 20 patients reported improved functional recovery, with significant reductions in DASH (median 112 to 50) and CBSQ (median 96 to 28) scores (p < 0.001).
• Pre- to post-surgery, temporary profile status decreased from 89% to 39%, and 61% passed physical fitness tests.
• 56% of patients achieved full return-to-duty status without limitations.

Conclusions:

• Supraclavicular thoracic outlet decompression effectively improves functional recovery in active duty military patients with nTOS.
• The surgical procedure leads to significant clinical improvement and enhanced physical capabilities.
• Further prospective studies are recommended to better define nTOS recovery in this specific population.