Impact of Work-Related Injury on the Recovery of Health-Care Workers after Surgery for Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) may arise as a sequela of injury. Work-related (WR) injuries have been reported to have poor TOS outcomes. Our goal is to assess impact of WR on health-care workers (HCW) (physicians, nurses, allied health) with TOS.

We reviewed a prospectively maintained TOS database of 1,800 cases and identified HCW who underwent TOS decompression surgery for WR injuries. These were compared to a contemporary HCW group who sustained nonwork-related (NWR) injury. Datapoints included demographics, work activities, and injuries. Outcomes were assessed by return to work, symptoms resolution, and standardized metrics (Somatic Pain Score, QuickDASH, and Derkash scores).

Forty-five HCW underwent surgery for injuries: 23 (51.1%) WR and 22 (48.9%) NWR. Patients were predominantly female (73.3%), median age 41.8 years. Distribution of professions differed between WR and NWR injuries: more physicians (WR 13.0% vs. NWR injuries 54.5%) and allied health (WR 17.7% vs. NWR injuries 22.7%) comprising NWR injuries, and more nurses (WR 69.6% vs. NWR injuries 22.7%) comprising WR (P = 0.004) injuries. Presentations of the subtypes of TOS did not differ between WR and NWR injuries: arterial TOS (WR 0.0% vs. NWR injuries 4.5%), venous TOS (WR 21.7% vs. NWR injuries 31.8%) and neurogenic TOS (WR 78.3% vs. NWR injuries 63.6%) (P = 0.40). Coexisting neck, shoulder, arm, and hand pathology was present in 17.4% WR and 13.6% NWR (P = 0.87). Median postoperative follow-up was 22.8 months. Most HCW with WR and NWR injuries were able to return to work (68% vs. 71%, P = 0.29) and experienced symptom resolution (84% vs. 95%, P = 0.23). Return to work was significantly higher among physicians (MDs) compared to nurses/nurse practitioners (RNs) and allied health-care workers (AHs), with 93% of MDs returning to work compared to 61% RNs and 43% AH (P = 0.03). Standardized metrics Somatic Pain Score, QuickDASH, and Derkash scores improved postoperatively in both groups.

Despite reported adverse impact of WR injury on TOS outcomes, there was no significant difference between WR and NWR injuries in HCW return to work or in symptom resolution. These findings are supported by improved standardized outcome metrics, showing no significant difference between groups. HCW returned to work and experienced symptom resolution regardless of injury mechanism. Higher rates of return to work among MDs may related to discrepancy in occupation-specific physical demands relative to RNs and AHs.