Post-traumatic neurogenic thoracic outlet syndrome: Clinical presentation and surgical outcomes-A retrospective...

ObjectivePost-traumatic neurogenic thoracic outlet syndrome remains an underreported condition, particularly in high-trauma and resource-limited settings. This study aimed to characterize the clinical presentation of post-traumatic neurogenic thoracic outlet syndrome and evaluate functional outcomes, recurrence, and factors associated with outcomes following surgical decompression.MethodsThis retrospective cohort study included 400 consecutive patients with post-traumatic neurogenic thoracic outlet syndrome who underwent supraclavicular thoracic outlet decompression between 2007 and 2024. Patients with arterial or venous thoracic outlet syndrome were excluded. All patients underwent first-rib resection with anterior and middle scalenectomy and excision of associated anomalous osseous structures when present. Functional outcomes were assessed using the disabilities of the arm, shoulder, and hand score. Recurrence-free survival was evaluated using Kaplan-Meier analysis, and multivariable regression was used to identify factors associated with recurrence and functional improvement. The follow-up duration ranged from 24 to 60 months.ResultsThe mean participant age was 36.1 ± 9.5 years, and 255 patients (63.7%) were women. Falls from height (27.3%), physical assault (26.0%), pedestrian injury (24.8%), and road traffic accidents (22.0%) were the principal trauma mechanisms. Cervical ribs were present in 37.0% and elongated transverse processes in 30.8% of the study participants. The mean disabilities of the arm, shoulder, and hand score decreased from 54.8 ± 9.0 preoperatively to 9.8 ± 6.0 postoperatively (p < 0.001). During follow-up, 120 patients (30.0%) developed recurrence. Cervical rib was associated with increased recurrence (odds ratio: 1.50, 95% confidence interval: 1.05-2.10; p = 0.02) and less functional improvement (β = -2.1; p = 0.04). Pneumothorax requiring chest-tube drainage occurred in 2.0%; no major neural or vascular injuries or perioperative deaths were recorded.ConclusionsIn this retrospective cohort, supraclavicular decompression was associated with substantial functional improvement in selected patients with persistent post-traumatic neurogenic thoracic outlet syndrome. Cervical rib may be associated with recurrence and less favorable functional recovery. Prospective multicenter studies are warranted to confirm these findings.