Neurogenic Thoracic Outlet Syndrome Reviewed

Abstract

Neurogenic Thoracic Outlet Syndrome (NTOS) is a rare, but controversial syndrome in relation to its diagnosis, treatment modality, and approaches in case of surgical treatment. In the English literature, there are sparse studies dealing with these aspects.
 We conducted a PubMed 2000-2017 literature review and found a total of 3953 cases reported with NTOS. The clinical characteristics, etiology, electrophysiological and radiological work-up and treatment options were reviewed and reported.
 It seems that, as far as surgical indication criteria are concerned, there is a consensus for NTOS in its motor deficit stage and its techniques are generally well established.
 This review showed that differential diagnosis, radiological, and electrophysiological criteria for correct diagnosis of NTOS are not controversial. However, surgical indications and types of approaches and techniques reflect the surgeon’s affiliation with specialties dealing with NTOS (vascular, plastic, hand, orthopedic or neurosurgeons), and the surgeon’s experience with this specific and rare syndrome.

Torasik Outlet Sendromunda Cerrahi Tedavinin Etkinliği

“…This rate is higher than many series reported in the literature. The full recovery rate of 78.4% in our study was also in accordance with the success rates of the studies done in our country, but one of the best success rates in the literature belongs to Sanders, who reported a 70% success rate [1,4]. The highest success rate ever reported was by Urschel in his series, at 97%.…”

“…In a long-term study, success rates were reported as 92% for transaxillary intervention, 83% for supraclavicular intervention, and 86% for posterior intervention. Postoperative complication rates do not exceed 4% in the literature [1,2,9,10,16], whereas in our study, the most common complication in 37 cases was pneumothorax, at 14 (37.8%). In contrast to the other series, there was no occurrence of the Horner syndrome, while hemothorax occurred in 2 cases (5.4%) and infection in 1 case (2.7%).…”

“…In our study, which included 37 cases, the average age was found to be 33.25 and this average was in accordance with the literature. Women account for 60-80% of thoracic outlet syndrome cases in all published series [1,2,4,9] and Jamieson reported this rate at 86% in his publication in 1996 [23]. In our study, 91.9% of the cases were females, however the regional situation of the clinic where the study was conducted and the gender distribution of the patients included may have had some effect on these results.…”

“…The upper trunk consisting of the C5-C7 roots of the brachial plexus is the most anatomic formation under pressure, affected by the hypertrophy of the scalene muscles: the pressure of the upper trunk leads to symptoms such as pain, numbness, weakness. The most common symptoms in TOS in the literature are reported as numbness, pain, weakness and the occurrence of these goes up to 95% in the literature [1,2,4,6,9,13]. In many publications, neurological symptoms are more common than vascular symptoms [1,2,9], therefore in our study we distinguished the symptoms into two main groups of vascular and neurological: of all the cases, 33 (89.2%) had symptoms of neurological origin and 2 (5.4%) had symptoms of vascular origin, whereas 2 cases (5.4%) had both neurological and vascular symptoms.…”

“…Therefore, it is not possible to talk about a complete correlation between anatomic pressure and symptoms, which leads to difficulties in the diagnosis. Taken together, the clinical experience of the physician in said cases is very important [1,2] In diagnosed patients, physical therapy methods accompanied by medical treatment are suggested as a first line treatment [3]. Medical treatment combined with physical therapy can lead to serious clinical relief, although it can never completely improve the current mechanical pressure [6].…”