Patient-Reported Outcomes from Supraclavicular Thoracic Outlet Decompression

The diagnosis of neurogenic thoracic outlet syndrome is based on patient history, provocative maneuvers, and, ultimately, the successful relief of symptoms following surgical decompression. We sought to understand patient-reported outcomes after thoracic outlet decompression.

All patients undergoing thoracic outlet decompression between July 2015 and July 2020 were identified from a single institutional database. Validated questionnaires including, Thoracic Outlet Syndrome Index, Short Form 20, Pain Catastrophizing Scale (PCS), Zung Self-Reporting Depression Scale, and nine of our own questions, were used to report patient outcomes from 10 individuals.

The Thoracic Outlet Syndrome Index, Zung Self-Reporting Depression Scale, Short Form 20 pain subscore, and PCS averages were 63 (± 44.3), 58.25 (± 5.04), 40.3 (± 17.5), and 22.6 (± 18.81), respectively. One hundred percent of patients indicated some level of depression with 50% indicating mild levels and 50% indicating moderate levels of depression. Pain was the most commonly reported improved symptom after surgery with 50% indicating a ≥95% improvement. Despite 80% of patients indicating surgery provided the results they were expecting, 60% still had some element of numbness in their arm or hand.

Thoracic outlet decompression can produce high levels of symptom improvement, especially in regards to pain. Lack of improvement can be related to a multitude of factors including confounding depression, pain catastrophizing/neurosis, inaccurate diagnosis of thoracic outlet syndrome, or double crush syndrome. More objective tests for identifying thoracic outlet syndrome may help to better understand which patients have a better likelihood of symptom improvement after surgery.

Symptom Prevalence Study III.