gms | German Medical Science

Objective: Thoracic outlet syndromes TOS are still believed to be exclusion diagnoses. Frequently, patients report on longstanding odysseys before eventually the correct diagnosis is made. In the past years high-resolution neurosonography HRNS and MR-neurography MRN has reached a new level of imaging quality and hence exert an important impact on nerve lesion assessment and thus on decision-making in treatment. In TOS, HRNS as a dynamic imaging modality plays a crucial role. We therefore present our results of preoperative HRNS and intraoperative findings to support the theory of TOS being a primary and not an exclusion diagnosis.

Methods: We retrospectively assessed the clinical charts of all TOS patients operated on in our institution from 2013 to 2017. Intraoperative findings were compared to preoperative HRNS findings.

Results: From 2013-2017 n=43 TOS procedures in n= 37 patients were performed in our institution. N= 31 presented with unilateral, n= 6 with bilateral TOS. N=3 patients were operated on before elsewhere. All patients were examined using HRNS preoperatively. Preoperative and intraoperative findings corresponded in n= 40/43 cases. Of these, compressive bony causes (cervical rib/ transverse processus of vertebra c7), alterations of median scalene muscles, accessory ligaments, vascular conflicts could be identified in all but one cases. In contrast, detection of Sibson fascia was possible in n= 2/3 cases.

Conclusion: According to our findings, preoperative HRNS reliably depicted the underlying pathology in the majority of TOS patients. Therefore, it seems to be an essential tool in the correct diagnosis of TOS. Applied by an experienced neurosonologist, HRNS facilitates primary diagnosis in TOS. In our experience, futile and time-consuming exclusion investigation seems to be dispensable.