Comparison of functional outcome of early surgical intervention of neurogenic thoracic outlet syndrome with late surgical treatment

Abstract EN

The aim of the study was to compare the outcome of early surgical intervention in recently diagnosed cases of neurogenic thoracic outlet syndrome (NTOS) with late surgical treatment after a trial of conservative management.

Patients and methods The study included 35 patients with NTOS (25 women and 10 men; aged 20–52 years) who were classified into two groups.

Patients in the first group (15 patients) were operated upon 6 months after medical and physical therapy; patients in the second group were operated upon within 3 months of onset.

All patients were operated upon using the supraclavicular surgical approach.

They were evaluated clinically and neurophysiologically and they answered the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire preoperatively and 6 months postoperatively for assessment of functional outcome.

Results Paresthesia and pain were seen to have improved significantly in group II compared with group I.

Muscle weakness was nonsignificantly less frequent in group II compared with group I.

Group II showed a significantly better sensory nerve action potential of the ulnar nerve and less denervation in electromyography compared with group I.

The postoperative DASH score improved in both groups but it was less statistically significant in group I compared with group II (Po0.05 in group I and Po0.001 in group II).

Conclusion We suggest that early surgical treatment for NTOS will improve functional disability, stop degeneration of nerves, and decrease the occurrence of muscle wasting and denervation of nerves compared with late surgery.