Somatosensory evoked potentials in the assessment of thoracic outlet compression syndrome

To evaluate the assessment of thoracic outlet compression syndrome (TOS) by objective methods, we prospectively studied a group of 80 consecutive patients with disabling TOS who had been selected for surgical therapy. Comprehensive pre- and postoperative neurophysiologic tests were used and included electromyography, nerve conduction times, F wave determination, and somatosensory evoked potentials (SEPs) of median and ulnar nerves in neutral and stressed positions. Measurements were made of Erb's point peak (N9), cervical peak (P/N13), and cortical complex (N18-P22). Amplitude ratios were calculated for each side, and interpeak latencies were measured for N9-P/N13, P/N13-N18, and N9-N18. SEP results were abnormal on the affected side in 59 of 80 patients (74%); ulnar peak amplitudes were either less than 33% of median, reduced by more than 50% in the stressed position, or reduced by more than 50% when compared with the contralateral side. Of 64 patients studied pre- and postoperatively with SEP, 40 of 47 abnormal tests showed improvement, with 30 of these returning to normal values in the early postoperative period. Excellent clinical correlation was evident in 43 of these 47 patients (92%) who had pre- and postoperative tests; with relief of symptoms reflected in improved SEP, or continued symptoms explained by evidence of persistent or residual nerve dysfunction. The present methodology and criteria for test interpretation demonstrate that SEP can document the neurocompressive component of TOS and provide an objective assessment of pre- and postoperative clinical observations.