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Related Experiment Videos

Thoracic outlet syndrome reconsidered

G V Poole1, K R Thomae

  • 1Department of Surgery, University of Mississippi Medical Center, Jackson, 39216, USA.

The American Surgeon
|April 1, 1996
PubMed
Summary

Thoracic outlet syndrome (TOS) is uncommon. Accurate diagnosis relies on history and physical exam, with imaging useful for ruling out other conditions. Careful patient selection for surgery improves outcomes.

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Area of Science:

  • Orthopedics
  • Neurology
  • Vascular Surgery

Background:

  • Thoracic outlet syndrome (TOS) can cause upper extremity pain and dysfunction.
  • Many patients undergo extensive, ineffective prior treatments.
  • Accurate diagnosis is crucial for effective management.

Purpose of the Study:

  • To evaluate diagnostic methods for TOS.
  • To assess treatment outcomes for patients with suspected TOS.
  • To identify factors influencing treatment success.

Main Methods:

  • Retrospective review of 50 patients evaluated for TOS over four years.
  • Inclusion of history, physical examination, and selective imaging studies (radiographs, EMG/NCS, CT, MRI, angiography, myelography).
  • Analysis of surgical and nonoperative treatment outcomes.

Main Results:

  • Only 12 patients were diagnosed with TOS; 7 underwent surgery with 4 complete resolutions and 3 partial improvements.
  • Unilateral subclavian artery compression on physical exam was the most valuable diagnostic finding.
  • Nonoperative management and physical therapy were effective for many patients without TOS.
  • Work-related symptoms and legal involvement correlated with poorer outcomes.

Conclusions:

  • History and physical examination are paramount for diagnosing TOS.
  • Imaging studies are primarily useful for excluding other pathologies.
  • Careful patient selection for surgical intervention is key to satisfactory outcomes.
  • A multidisciplinary approach involving surgeons, neurologists, and physical therapists is recommended for TOS management.

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