gms | German Medical Science

Objectives/Interrogation: The thoracic outlet syndrome represents a nerve compression syndrome at the root and trunc level of the brachial plexus. The diagnosis is a clinical one, no imaging or neurophysiological monitor system is available for diagnostic purpose. The clinical symptoms mainly center on a compression neuropathy of the inferior trunc, A substantial number of patients have unsuccessfully been operated for peripheral nerve compression syndromes. The surgical results of decompression at the truncular level lead to unsatisfactory results in a number of cases. With this study, a new surgical approach is presented.

Methods: From 10/02 to 3/17 142 operative decompressions were performed in our unit, in 28 cases bilaterally. Following the hypothesis, that resection of the first rib would not provide adaequate decompression, one of the authors started in 2012 to perform an exarticulation of the first rib. We now present an evaluation of 80 exarticulations vs. 62 resections, with respect to the clinical outcome.

The underlying gradig scheme uses 5 categories: 0 (no symptoms), 1 (Symptoms with heavy physical stress), 2 (Symptoms under moderate physical stress), 3 (Symptoms under light physical stress, frequent analgetic medication), 4 (permanent sympoms, sensory and motor deficits, permanent anagetic medication).

Results and Conclusions: Indication for operative decompression was a TOS stage 3 and 4. Evaluation was performed at a minimum of one year postop. The two groups were comparable according to mean age, female to male ratio and severity of symptoms at the time of operative intervention.

As a result, the exarticulation group presented with significantly better clinical outcomes.

These results will be analysed with respect to the underlying anatomic causes.