gms | German Medical Science

Objectives/Interrogation: Thoracic outlet syndrome is a rare neuro-vascular compression syndrome affecting the upper limb with various vascular and /or neurologic symptoms, frequently including neuropathic pain. When the vascular or neurologic etiology is unclear and pain the pertinent symptom, patients may be admitted to the hospital for 2 to 3 weeks of interdisciplinary treatment involving anaesthetists, physio- and ergo therapist, psychologist under coordination of the hand surgeon, all together in a specific therapeutic frame recognised by the national health system.

We present our 3 years experience with this modality allowing us not only to efficiently treat these patients, but to sort out operative indications in disputed thoracic outlet syndrome cases.

Methods: Between 2016 and 2018, 20 patients were admitted in our hand surgery department for evaluation and multidisciplinary pain treatment. The standardised protocol for pain (VAS) and functional impairment assessment was applied and treatment assumed by all participating disciplines.

Our retrospective review concentrated on patient characteristics, comorbidities, pain relief and eventual surgical indication.

Results and Conclusions: Patients were representative of all age groups within the working community. Subjective improvement of pain was reached in all patients, 3 underwent secondary hand surgery, none a surgical decompression for a hypothized TOS syndrome.

Patient compliance was high and complication rate low (2 superficial infections at the pain catheter skin insertion).

This treatment modality is a useful tool when sorting out "disputed" TOS patients for a surgical indication, while the interdisciplinary pain treatment allows a lot of new insights and therapeutic actions in a chronic course of severe neuropathic pain and certainly avoids undue or complex surgery in selected patients.