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:10.2139/ssrn.3712943

Cited by 4 publications

(7 citation statements)

References 14 publications

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“…The outcomes used in the study were TOS disability scale (TDS), cervical brachial questionnaire (CBSQ) etc. In this study they concluded that the severe grade of TOS requires physical therapy while during initial stages or in moderate cases of TOS it can be managed by physical therapy [5].…”

Section: Discussionmentioning

confidence: 91%

Conservative Management of Cervical Rib- A Case Report

Agrawal¹,

Uttamchandani²,

Deshmukh³

et al. 2021

JPRI

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Background: An additional rib that develops from the seventh cervical vertebra is known as a cervical rib, a congenital anomaly placed above the typical first rib, affecting 0.2- 0.5 percent of the total population. It may be seen on either the left or right sides. The majority of patients have little or no complaints and are identified by chance during an X-ray or CT scan. Due to the extreme compression on the arteries, veins and nerves caused by the position of the rib, which varies in shape and size, they might develop thoracic outlet syndrome. A cervical rib is a prolonged ossification of the lateral costal segment of the Cervical 7th vertebra. Clinical Presentation: A 18 years old female patient was diagnosed with cervical rib on X-ray due to persistent pain at right hand. Patient concern with reduced mobility of the right upper limb and unable to lift the hand. The patient went physiotherapy treatment which comprise of exercise and electro therapy for 10 weeks which resulted in improvements in pain and range of motion and functional activities Conclusion: The case report suggest that a prompt structured physical rehab let to improving the functional goals progressively and significantly which is a measured aspect leading to a successful recovery.

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Section: Discussionmentioning

confidence: 91%

Conservative Management of Cervical Rib- A Case Report

Agrawal¹,

Uttamchandani²,

Deshmukh³

et al. 2021

JPRI

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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 the Consortium for Outcomes Research and Education on Thoracic Outlet Syndrome and SVS criteria for a diagnosis of recurrent NTOS. [9][10][11][12] The mean duration of the 3minute Elevated Arm Stress Test was 73.9 ± 5.6 seconds, and the mean QuickDASH score before reoperation was 65.2 ± 2.6, reflecting a substantial level of disability. 11 Only 25 patients (29%) were working full time at presentation, with 6 (7%) working part time under restrictions and 36 (42%) being disabled or unemployed.…”

Section: Presenting Characteristicsmentioning

confidence: 99%

“…9-12 Physical therapy and pain management can improve symptoms in many patients with NTOS, but surgical treatment is recommended for those with disabling symptoms and failure to improve with conservative measures. 11-14 Surgical decompression can be safely conducted through transaxillary, supraclavicular, or posterior approaches, with excellent early results and sustained outcomes. 15-25…”

mentioning

confidence: 99%

“…1-8 NTOS arises because of predisposing variations in anatomy and neck or upper extremity injury, with diagnosis requiring exclusion of other conditions and specific clinical criteria. 9-12 Physical therapy and pain management can improve symptoms in many patients with NTOS, but surgical treatment is recommended for those with disabling symptoms and failure to improve with conservative measures. 11-14 Surgical decompression can be safely conducted through transaxillary, supraclavicular, or posterior approaches, with excellent early results and sustained outcomes.…”

mentioning

confidence: 99%

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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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