Long-Term Functional Results for the Surgical Management of Neurogenic Thoracic Outlet Syndrome

Abstract

Durable long-term functional outcomes can be achieved predicated on a highly selective approach to the surgical management of patients with NTOS. A majority of operated patients will not require adjunctive procedures or chronic narcotic utilization. Patients who undergo surgery can expect to return to work with little or no functional impairment.

Impact of anterior scalene lidocaine blocks on predicting surgical success in older patients with neurogenic thoracic outlet syndrome

“…3,7,8 It could be postulated that, similar to various other complex regional pain syndromes, persistent repetitive stimulation of central pain pathways over time results in autonomous signal generators that could confound results. 4,9 However, to the best of our knowledge, our study is the first to show that this association was more closely associated with age. Each additional month of symptoms in the patient group Ն40 years was associated with a significant decrease in successful outcome.…”

“…This underscores the importance of careful patient selection by distinguishing between the diagnoses as well as the use of appropriate adjunctive tests to optimize the results of surgical outcomes. [4][5][6] There have been few risk factors and predictors that have been implicated to affect successful surgical outcomes. Among some of the factors that were evaluated in our study included the affect of age, duration of symptoms, and impact of anterior scalene blocks.…”

“…4,6,10 The accuracy of these procedures to selectively inject the anterior scalene muscle can be further increased with the adjunctive use of electromyography, 6 ultrasonography, 11 and computed tomography. 12 These findings suggest that positive anterior scalene blocks assist in offering a confirmatory diagnosis of NTOS and seem useful in differentiating other overlapping diagnoses that may influence surgical outcome and predict which patients are more likely to benefit from surgery.…”

“…Nevertheless, more contemporary series in the literature have reported achieving durable results and better outcomes after surgical decompression for NTOS by using stringent patient selection criteria. 4,5 This underscores the importance of patient selection and stratification, one of which in our practice is the utilization of adjunctive anterior scalene blocks preoperatively. Clinically, we had also noticed a trend in slightly poorer surgical outcomes among older patients.…”

Supraclavicular Scalenectomy for Thoracic Outlet Syndrome—Functional Outcomes Assessed Using the DASH Scoring System

“…This correlates well with that reported elsewhere, 7 with published work noting trauma in 15% to 80%, 19,20 although McCarthy et al did not find this in the history of any of their cohort. 17 We have found that those patients whose etiology included traumatic injury did not demonstrate improved DASH scores postoperatively; in contrast, significant improvement was noted in those who had not reported this as an etiological factor.…”