Feasibility and Outcomes of a Multidisciplinary Care Pathway for Neurogenic Thoracic Outlet Syndrome: A Prospective Observational Cohort Study

Pesser, Niels; Goeteyn, Jens; Sanden, Lieke van der; Houterman, Saskia; Alfen, Nens van; Sambeek, Marc R.H.M. van; Nuenen, Bart F.L. van; Teijink, Joep A.W.

doi:10.1016/j.ejvs.2021.02.048

Cited by 24 publications

(22 citation statements)

References 26 publications

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“…In patients with mild symptoms, TOS treatment can be conservative, involving physiotherapy, massage, and kinesitherapy [ 22 ]. When compressions are significant (>70%), surgery is the treatment of choice [ 23 ]. The surgical treatment is scalenectomy, usually combined with first rib or cervical resection, and may require scar tissue lysis around neurovascular structures aimed at decompression of the involved structures.…”

Section: Thoracic Outlet Syndromementioning

confidence: 99%

Vascular compression syndromes: a pictorial review

et al. 2022

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Vascular compression syndromes include a group of rare changes due to extrinsic compression of veins or arteries by surrounding structures. Often these pathologies are underestimated due to the rarity, poor knowledge and non-specificity of symptoms. The best known are Eagle syndrome, Thoracic Outlet syndrome, Nutcracker syndrome, May-Thurner syndrome, Dunbar syndrome and Popliteal Entrapment syndrome. This work summarizes the main ultrasonographic characteristics, symptoms and treatments of choice. Knowledge of these characteristic signs is essential for the differential diagnosis. Failure to diagnose these rare diseases can expose patients to serious complications and risks to their health.

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Section: Thoracic Outlet Syndromementioning

confidence: 99%

Vascular compression syndromes: a pictorial review

et al. 2022

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“…Patients with arterial or venous TOS were excluded, as were patients with neurogenic symptoms combined with either of the vascular forms of TOS, in accord with Society for Vascular Surgery (SVS) reporting standards. [9][10][11][12] During the study interval, 1561 patients underwent surgical treatment for NTOS, of which 238 (15%) were reoperative procedures (Figure 1). Reoperative procedures conducted after previous operations at other institutions (n = 90) were excluded as the subjects of a recently published study.…”

Section: Derivation Of the Study Populationmentioning

confidence: 99%

“…Each patient met clinical diagnostic criteria for NTOS as developed by the Consortium for Outcomes Research and Education on Thoracic Outlet Syndrome and the SVS reporting standards. [9][10][11][12] Presenting symptoms typically consisted of pain, numbness, and paresthesia affecting the neck and upper extremity, with characteristic physical examination findings of localizing tenderness and reproduction of upper extremity symptoms on palpation over the supraclavicular space and during provocative maneuvers. The level of functional disability was assessed using the 11-item version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) survey instrument, which has been validated for various upper extremity disorders including NTOS.…”

Section: Clinical Diagnosis Disability and Initial Treatmentmentioning

confidence: 99%

Reoperative Brachial Plexus Neurolysis After Previous Anatomically Complete Supraclavicular Decompression for Neurogenic Thoracic Outlet Syndrome: A 10-Year Single-Center Case Series

Jammeh

Yang

Abuirqeba

et al. 2022

Operative Neurosurgery

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BACKGROUND: Optimal management of recurrent neurogenic thoracic outlet syndrome (NTOS) remains a considerable challenge. OBJECTIVE: To assess the safety and effectiveness of reoperative brachial plexus neurolysis in patients with recurrent NTOS. METHODS: From 2009 to 2019, 85 patients underwent reoperative supraclavicular brachial plexus neurolysis for recurrent NTOS after a previous anatomically complete supraclavicular decompression. Data from a prospectively maintained database were analyzed retrospectively. RESULTS: The mean patient age at reoperation was 36.9 ± 1.3 (range 15-64) years, 75% were female, and the interval after previous primary operation was 2.5 ± 0.2 years. Intervening injury had precipitated recurrent NTOS in 14 patients (16%), and the mean Disability of the Arm, Shoulder, and Hand (QuickDASH) score before reoperation was 65.2 ± 2.6, reflecting substantial disability. Operative findings consisted of dense fibrous scar tissue surrounding/encasing the brachial plexus. Compared with the previous primary operations, reoperations had a shorter operative time (198 ± 4 vs 161 ± 5 minutes, P < .01) and hospital stay (4.4 ± 0.2 vs 3.6 ± 0.1 days, P < .01), but there were no significant differences in the frequency of prolonged hospitalization (7.1% vs 4.7%), early reoperation (3.5% vs 1.2%), or 30-day hospital readmission (8.2% vs 7.1%). During a median follow-up of 4.8 years, QuickDASH scores improved by 23.3 ± 2.6 (34.2% ± 3.6%; P < .01) and patient-rated outcomes were excellent in 24%, good in 42%, fair in 26%, and poor in 8%. CONCLUSION: Reoperative supraclavicular brachial plexus neurolysis is technically challenging but safe and effective treatment for recurrent NTOS, with significant improvements in symptoms and function. Diminishing perineural scar tissue development and avoiding secondary injury would likely decrease the need for reoperations.

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“…Neurological thoracic outlet syndrome (NTOS) accountsfor ∼80%−97% of patients with thoracic outlet syndrome (TOS) (1,2). Treating priorities with rehabilitation training and analgesia can significantly improve outcomes for most patients (3)(4)(5). Surgical treatment may be considered for patients whose conservative treatment was not effective or worsened for more than 6 months (6).…”

Section: Introductionmentioning

confidence: 99%

Derkash's Classification and Vas Visual Analog Scale to Access the Long-Term Outcome of Neurothoracic Outlet Syndrome: A Meta-Analysis and Systematic Review

et al. 2022

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ObjectiveMany publications report outcomes of surgical treatment for neurothoracic outlet syndrome (NTOS); however, high-quality meta-analyses regarding objective evaluation system accessing the long-term outcome of NTOS are lacking. This meta-analysis summarizes and compares the outcomes of Derkosh's classification and vas visual analog scale of the supraclavicular neuroplastic of brachial plexus (SNBP) and trams auxiliary first rib resection (TFRR).MethodsThe Cochrane Library, PubMed, EMBASE, Allied and Complementary Medicine (AMED) were searched for papers published between January 1980 and February 2021, using the keywords “thoracic outlet syndrome,” “treatment, surgical.” Articles were eligible for inclusion if the following criteria were met studies describing outcomes of surgery for NTOS, published in English, human studies, and available in full text. The exclusion criteria were case reports (n < 10), reviews, abstracts, and studies lacking a control group or without evaluation for two types of surgery.ResultsWe included 10 studies with 1,255 cases, out of which 622 were in the SNBP group; and 633 were in the TFRR group. After surgery (≥12 months), Derkash's classification was improved in 425 cases with SNBP and 364 cases with TFRR. OR = 1.34 (95% CI: 0.94, 1.92), P = 0.03; vas visual analog scale was improved in 282 cases in the SNBP group and 214 cases in the TFRR group. OR = 1.08 (95% CI: 0.63, 1.85), P = 0.78.ConclusionThis meta-analysis shows that both SNBP and TFRR are effective for NTOS, but that SNBP is better than TFRR in improving Derkash's classification in the long term. Although patients treated with SNBP are more satisfactory, there is no significant difference in vas visual analog scale from TFRR.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021254203, PROSPERO CRD42021254203.

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Feasibility and Outcomes of a Multidisciplinary Care Pathway for Neurogenic Thoracic Outlet Syndrome: A Prospective Observational Cohort Study

Cited by 24 publications

References 26 publications

Vascular compression syndromes: a pictorial review

Vascular compression syndromes: a pictorial review

Reoperative Brachial Plexus Neurolysis After Previous Anatomically Complete Supraclavicular Decompression for Neurogenic Thoracic Outlet Syndrome: A 10-Year Single-Center Case Series

Derkash's Classification and Vas Visual Analog Scale to Access the Long-Term Outcome of Neurothoracic Outlet Syndrome: A Meta-Analysis and Systematic Review

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