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Predicting outcomes in thoracic outlet syndrome

D T Lai¹, J Walsh, J P Harris

¹Royal Prince Alfred Hospital, Sydney, NSW.

The Medical Journal of Australia

|April 3, 1995

Summary

Abnormal somatosensory evoked potentials (SEP) and photoplethysmography (PPG) predict better outcomes for thoracic outlet syndrome surgery. These diagnostic tests can help determine patient prognosis and guide treatment decisions.

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Area of Science:

Neurology
Vascular Surgery
Diagnostic Imaging

Background:

Thoracic outlet syndrome (TOS) is a complex condition affecting the nerves and blood vessels in the shoulder.
Surgical decompression is a common treatment for TOS, but predicting surgical success can be challenging.

Purpose of the Study:

To evaluate if somatosensory evoked potentials (SEP) and arterial photoplethysmography (PPG) can predict surgical outcomes in patients with TOS.
To test the hypothesis that preoperative SEP and PPG results correlate with postsurgical recovery.

Main Methods:

A retrospective case series analyzed 46 patients undergoing TOS surgery.
Preoperative SEP and PPG tests were correlated with surgical outcomes using Fisher's exact test.
Abnormal SEP indicated reduced amplitudes/delayed latencies; abnormal PPG indicated complete pulse loss.

Main Results:

A total of 63 limbs were operated on, with a mean follow-up of 5.7 years.
Limbs with abnormal SEP or PPG results showed significantly better outcomes (93%) compared to those with normal results (60%) (P = 0.02).
Good outcome was defined by symptom improvement and return to pre-illness activities.

Conclusions:

Abnormal SEP and PPG findings are associated with improved postsurgical outcomes in TOS patients.
These electrophysiological and vascular tests can assist in predicting the prognosis of TOS surgery.
SEP and PPG may serve as valuable tools for patient selection and outcome expectation management.

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