Treating Thoracic Outlet Syndrome Through Minimally Invasive Surgery

thoracic outlet syndromeTwo newly published studies have found that minimally invasive surgery for neurogenic thoracic outlet syndrome (NTOS) can significantly improve patients’ symptoms. This relatively uncommon condition causes neck pain, paraesthesia in the arms, neck and hands, numbness and weakness in the upper body and is more frequent in young, active and generally healthy patients.

One of the studies found that a fairly recently developed type of surgery is particularly helpful at relieving thoracic outlet syndrome in adolescents when the pinched nerves are being caused by the pectoralis minor tendon.

New Surgical Option for Thoracic Outlet Syndrome

The research was published in February in the Journal of Vascular Surgery and was carried out by senior author Robert W. Thompson, MD, professor of surgery and director of the Washington University Center for Thoracic Outlet Syndrome at Barnes-Jewish Hospital in St. Louis, Missouri, and colleagues. The first study looked at 200 patients referred to the hospital for treatment of disabling NTOS over a three and a half year period (2008-2011) with some patients undergoing the relatively new type of surgery and others having this surgery combined with another procedure in order to compare the results.

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome (TOS) usually involves neck pain and occipital headaches (at the base of the skull), arm weakness and tingling (paraesthesia) in the upper extremities. It can also cause chest pain and this, as with the other symptoms, may make it particularly hard to diagnose. More than 80% of cases are thought to be a consequence of brachial plexus injury, often during contact sports or as a result of a car accident and whiplash where the ligaments, tendons and musculature in the neck and upper chest have been hyper-extended. Diagnosing thoracic outlet syndrome can be difficult as x-rays and nerve tests do not provide sufficient evidence for the diagnosis. Instead, physicians must rely on a full medical history and physical examination.

Nerve Compression and Neck Pain in NTOS

The new technique was developed based on the realization that some patients have nerve compression in the space underneath the pectoralis minor muscle tendon close to the shoulder (known as the subcoracoid space). Thoracic outlet syndrome is a result of compression of the brachial plexus nerves that branch through the neck above the collarbone and down into the chest and underneath the collarbone. Determining the site of compression is vital for performing precise surgery to relieve the pinched nerves causing neck pain and other symptoms of NTOS.

thoracic outlet syndrome PMT surgery for neck pain from pinched nerves

The brachial plexus is a complex region where nerves can easily become trapped and compressed, causing NTOS.

Causes of TOS and How New Surgery Helps

In some cases the patient may have a cervical rib that is causing the compression and removal of this may relieve symptoms. In other cases a muscle tear or injury can be the cause of pinched nerves due to scar tissue. The new minimally invasive surgery is referred to as pectoralis minor tenotomy (PMT) and involves the severing of the pectoralis minor tendon so as to free the nerves trapped beneath. This study aimed to provide some insight as to the effectiveness of this procedure which remains novel.

How the Study Measured Success

The majority of the patients (143) underwent open surgery combining PMT with supraclavicular decompression (SCD+PMT), while 57 patients had minimally invasive PMT for thoracic outlet syndrome. Patients were diagnosed using standard clinical guidelines including pain in the armpits, clavicle, and front of the chest that suggested involvement of the pectoralis minor tendon. To measure the success of the procedure, patients were scored on the Disabilities of Arm, Shoulder, and Hand survey, the Cervical-Brachial Symptom Questionnaire, and a 10-point visual analog scale for pain. An index for NTOS was compiled from these results, with low disability scores around 0 and severe disability scores approaching the top of the scale at 100.


Significant Improvement in Symptoms of TOS

Patients’ most common symptoms prior to surgery were neck pain and shoulder pain, as well as pain in the arms, weakness and tingling or altered sensation in the hands. The two groups of patients, those undergoing PMT and those undergoing SCD+PMT, had NTOS index scores of 54.5 ± 3.4 (n35) and 62.7 ± 2.3 (n113); the difference was insignificant. Patients were then assessed after surgery and at a three month follow-up with 82% of all patients reporting significant and progressive improvement in their symptoms.

Endoscopic Surgery A New Option for TOS

The combined procedure had a slightly higher success rate with some 84% of patients reporting improvement at three months compared to 75% of the patients undergoing the new procedure alone. The NTOS index scores fell in both groups but the differences between the two were insignificant (36.8 ± 3.8 from 26 PMT patients, 41.3 ± 2.5 from 84 SCD+PMT patients). The comparable benefits of the isolated procedure suggest that it is a viable alternative to traditional open surgery for thoracic outlet syndrome.

Benefits for Adolescents with NTOS

The focus of the second study was comparing the benefits of adding PMT to the traditional open SCD procedure by looking at 35 adolescents (average age 17.3 years) and a group of 154 adults (mean average age of 40 years). Aside from a reduced incidence of hand pain in the adolescents (56% compared to 79%), the symptoms were generally similar between the groups. All of the patients had the SCD procedure and some had additional PMT if the clinical signs indicated a potential benefit.

Vast Improvements for Younger Patients

NTOS index scores pre-surgery were 46.5 ± 3.6 for the adolescents and 58.5 ± 1.7 for the adults. These scores dropped remarkably for the adolescents by three month follow-up (18.4 ± 4.1), and even further by the six month follow-up (10.4 ± 3.1). In the adults the results were less convincing with scores of 41.0 ± 2.3, at three months and 39.3 ± 3.3 at six months. This greater improvement in the adolescent group is likely due to a number of factors including the lower incidence of depression in the adolescents, fewer patients having experienced car crashes, less use of opiate painkillers, shorter symptom duration, and a higher incidence of repetitive motion injuries and sports participation.

Long-Term Outcomes for New TOS Surgery

One word of caution from the researchers, however, is that the study period was insufficient to monitor for the potential recurrence of symptoms of thoracic outlet syndrome which may reappear around two years after surgery. As the adolescents’ bodies are still growing and developing it may be that further nerve compression arises and symptoms appear once again. Long-term studies are, therefore, needed to monitor the continued success of these procedures. The two studies do support the use of this new surgical procedure for neurogenic thoracic outlet syndrome, however, especially in adolescents and a minimally invasive surgery for the condition may also reduce surgical risks for patients.

References


Thompson, R.W., et al, J Vasc Surg. Published online February 4, 2013, and 2013;57:149-157. Abstract


If you enjoyed this post make sure you’re the first to see future updates by liking the PainNeck.com Facebook page!

180 replies
  1. QQ188
    QQ188 says:

    Good write-up, I¦m normal visitor of one¦s blog, maintain up the nice operate, and It’s going to be a regular visitor for a lengthy time.

    Reply
  2. badcreditloans com bbb
    badcreditloans com bbb says:

    Thanks for sharing superb informations. Your web site is so cool. I am impressed by the details that you have on this web site. It reveals how nicely you understand this subject. Bookmarked this website page, will come back for more articles. You, my friend, ROCK! I found simply the info I already searched all over the place and simply could not come across. What a great site.

    Reply
  3. Do gas stations sell CBD disposables?
    Do gas stations sell CBD disposables? says:

    What i do not realize is in reality how you’re no longer actually much more well-liked than you may be right now. You’re so intelligent. You understand therefore considerably in terms of this subject, made me for my part imagine it from numerous various angles. Its like men and women aren’t involved until it?¦s one thing to accomplish with Girl gaga! Your personal stuffs great. Always handle it up!

    Reply
  4. instagram password hacker
    instagram password hacker says:

    obviously like your web site but you need to check the spelling on several of your posts. Many of them are rife with spelling issues and I to find it very troublesome to inform the truth however I will certainly come again again.

    Reply
  5. CBD Disposables
    CBD Disposables says:

    Fantastic items from you, man. I’ve be mindful your stuff previous to and you’re just too wonderful. I actually like what you’ve bought right here, certainly like what you are stating and the best way during which you are saying it. You make it enjoyable and you continue to care for to keep it smart. I can’t wait to read much more from you. This is really a tremendous web site.

    Reply
  6. backlinks SEO
    backlinks SEO says:

    Thanks for sharing excellent informations. Your web site is so cool. I am impressed by the details that you have on this website. It reveals how nicely you understand this subject. Bookmarked this web page, will come back for extra articles. You, my friend, ROCK! I found simply the information I already searched everywhere and simply could not come across. What a perfect site.

    Reply
  7. How long do CBD disposables take to kick in?
    How long do CBD disposables take to kick in? says:

    I’ve been browsing online greater than three hours lately, yet I never discovered any fascinating article like yours. It’s lovely price sufficient for me. In my opinion, if all web owners and bloggers made good content as you did, the internet will probably be a lot more helpful than ever before. “When there is a lack of honor in government, the morals of the whole people are poisoned.” by Herbert Clark Hoover.

    Reply
  8. does cbd oil help with respiratory infections
    does cbd oil help with respiratory infections says:

    Today, I went to the beach front with my kids. I found a sea shell and gave it to my 4 year old daughter and said “You can hear the ocean if you put this to your ear.” She placed the shell to her ear and screamed. There was a hermit crab inside and it pinched her ear. She never wants to go back! LoL I know this is completely off topic but I had to tell someone!

    Reply
  9. does cbd oil help cancer
    does cbd oil help cancer says:

    Hiya very cool website!! Guy .. Beautiful .. Superb .. I will bookmark your website and take the feeds also?KI am satisfied to search out a lot of helpful info here within the submit, we need work out more strategies in this regard, thank you for sharing. . . . . .

    Reply
  10. ทิ้งชุดชั้นใน
    ทิ้งชุดชั้นใน says:

    Great – I should definitely pronounce, impressed with your site. I had no trouble navigating through all the tabs as well as related info ended up being truly easy to do to access. I recently found what I hoped for before you know it in the least. Reasonably unusual. Is likely to appreciate it for those who add forums or something, website theme . a tones way for your client to communicate. Excellent task..

    Reply
  11. MPO555
    MPO555 says:

    Everyone loves what you guys tend to be up too. This kind of clever work and exposure! Keep up the wonderful works guys I’ve incorporated you guys to my personal blogroll.

    Reply
  12. mila 23
    mila 23 says:

    magnificent issues altogether, you just gained a emblem new reader. What might you recommend about your post that you made some days ago? Any sure?

    Reply
  13. ลิปซอง
    ลิปซอง says:

    Hey! This is my 1st comment here so I just wanted to give a quick shout out and say I really enjoy reading your blog posts. Can you suggest any other blogs/websites/forums that deal with the same subjects? Thank you!

    Reply
  14. ผื่นขึ้นหน้า
    ผื่นขึ้นหน้า says:

    Thanks a lot for providing individuals with a very brilliant possiblity to read in detail from this site. It is often so sweet plus stuffed with amusement for me and my office colleagues to visit your blog on the least 3 times weekly to learn the new issues you have. And of course, we are actually satisfied concerning the eye-popping advice you serve. Selected 2 tips on this page are without a doubt the most suitable I’ve had.

    Reply
  15. professional cell phone hackers
    professional cell phone hackers says:

    Hello there, simply changed into alert to your blog via Google, and located that it is really informative. I am gonna be careful for brussels. I’ll be grateful for those who proceed this in future. A lot of other people shall be benefited out of your writing. Cheers!

    Reply
  16. remote cell phone hackers
    remote cell phone hackers says:

    Excellent beat ! I wish to apprentice while you amend your website, how can i subscribe for a blog website? The account helped me a applicable deal. I have been a little bit familiar of this your broadcast provided bright transparent concept

    Reply
  17. cell phone hackers for hire
    cell phone hackers for hire says:

    I’m really enjoying the design and layout of your website. It’s a very easy on the eyes which makes it much more pleasant for me to come here and visit more often. Did you hire out a developer to create your theme? Outstanding work!

    Reply
  18. situs slot online pulsa
    situs slot online pulsa says:

    The following time I read a weblog, I hope that it doesnt disappoint me as a lot as this one. I mean, I know it was my choice to read, but I really thought youd have one thing fascinating to say. All I hear is a bunch of whining about something that you could possibly repair if you werent too busy looking for attention.

    Reply
  19. UGSLOT
    UGSLOT says:

    I’m still learning from you, but I’m trying to reach my goals. I absolutely love reading all that is posted on your website.Keep the posts coming. I liked it!

    Reply
  20. slot deposit pulsa
    slot deposit pulsa says:

    We stumbled over here different web page and thought I should check things out. I like what I see so i am just following you. Look forward to looking into your web page for a second time.

    Reply
  21. Slot Gacor Deposit Pulsa
    Slot Gacor Deposit Pulsa says:

    Its like you read my mind! You appear to know so much about this, like you wrote the book in it or something. I think that you can do with some pics to drive the message home a bit, but instead of that, this is excellent blog. A great read. I will certainly be back.

    Reply
  22. Vorteil Hunde
    Vorteil Hunde says:

    Thanks for sharing superb informations. Your site is so cool. I’m impressed by the details that you have on this blog. It reveals how nicely you understand this subject. Bookmarked this web page, will come back for more articles. You, my pal, ROCK! I found simply the information I already searched all over the place and simply could not come across. What a great web site.

    Reply
  23. Data Science do Zero Minerando Dados
    Data Science do Zero Minerando Dados says:

    You really make it appear so easy along with your presentation however I find this topic to be really something that I feel I might by no means understand. It seems too complicated and very vast for me. I am taking a look ahead in your subsequent publish, I’ll try to get the hold of it!

    Reply
  24. legitimate work from home jobs in texas usa
    legitimate work from home jobs in texas usa says:

    Needed to create you a little remark to help thank you as before about the beautiful basics you’ve contributed here. This is tremendously generous with people like you to grant unhampered what many of us might have distributed for an ebook to help with making some cash for their own end, primarily given that you might have done it in the event you desired. The techniques also worked to be the easy way to know that many people have similar dream just as my very own to see a good deal more related to this condition. I think there are a lot more pleasant moments up front for individuals that looked at your blog post.

    Reply
  25. Is Full Spectrum CBD Good or Bad?
    Is Full Spectrum CBD Good or Bad? says:

    hey there and thanks to your information – I have certainly picked up anything new from right here. I did on the other hand experience several technical issues the use of this website, since I experienced to reload the web site a lot of times previous to I may get it to load properly. I had been thinking about if your hosting is OK? Now not that I am complaining, however slow loading circumstances occasions will very frequently affect your placement in google and can harm your quality score if advertising and ***********|advertising|advertising|advertising and *********** with Adwords. Well I am adding this RSS to my email and can look out for a lot extra of your respective exciting content. Make sure you replace this once more very soon..

    Reply
  26. karya hamka
    karya hamka says:

    Nice post. I be taught something tougher on completely different blogs everyday. It’ll at all times be stimulating to learn content from other writers and apply slightly one thing from their store. I’d choose to make use of some with the content on my blog whether you don’t mind. Natually I’ll provide you with a link in your internet blog. Thanks for sharing.

    Reply
  27. forest hill homes for sale
    forest hill homes for sale says:

    Hello, i read your blog from time to time and i own a similar one and i was just wondering if you get a lot of spam responses? If so how do you prevent it, any plugin or anything you can recommend? I get so much lately it’s driving me insane so any help is very much appreciated.

    Reply
  28. carreiras policiais 2022 download cursos grátis
    carreiras policiais 2022 download cursos grátis says:

    What i don’t understood is in fact how you’re no longer actually a lot more well-favored than you might be right now. You are so intelligent. You already know therefore significantly in relation to this subject, made me for my part believe it from numerous various angles. Its like women and men aren’t fascinated except it is something to do with Girl gaga! Your personal stuffs excellent. At all times handle it up!

    Reply
  29. master cursos
    master cursos says:

    Hey There. I found your blog using msn. This is an extremely well written article. I will be sure to bookmark it and come back to read more of your useful information. Thanks for the post. I will certainly return.

    Reply
  30. fittings
    fittings says:

    I do not even understand how I ended up here, however I assumed this publish was great. I do not realize who you are but certainly you’re going to a famous blogger if you are not already 😉 Cheers!

    Reply
  31. vip chauffeur
    vip chauffeur says:

    wonderful put up, very informative. I’m wondering why the other specialists of this sector do not realize this. You should continue your writing. I am confident, you have a huge readers’ base already!

    Reply
  32. hire a hacker online
    hire a hacker online says:

    Hi there! Do you know if they make any plugins to help with Search Engine Optimization? I’m trying to get my blog to rank for some targeted keywords but I’m not seeing very good results. If you know of any please share. Cheers!

    Reply
  33. hire a hacker
    hire a hacker says:

    Its like you read my thoughts! You seem to understand a lot about this, such as you wrote the e book in it or something. I feel that you just can do with a few percent to power the message home a bit, but other than that, this is wonderful blog. A great read. I will certainly be back.

    Reply
  34. hire a hacker to catch cheating spouse
    hire a hacker to catch cheating spouse says:

    Its like you learn my thoughts! You appear to know so much about this, such as you wrote the guide in it or something. I believe that you simply can do with a few p.c. to power the message house a little bit, but instead of that, this is fantastic blog. A fantastic read. I will certainly be back.

    Reply
  35. chauffeur hire near me
    chauffeur hire near me says:

    This blog is definitely rather handy since I’m at the moment creating an internet floral website – although I am only starting out therefore it’s really fairly small, nothing like this site. Can link to a few of the posts here as they are quite. Thanks much. Zoey Olsen

    Reply
  36. fisioterapi
    fisioterapi says:

    Hello, you used to write wonderful, but the last several posts have been kinda boring… I miss your tremendous writings. Past few posts are just a little bit out of track! come on!

    Reply
  37. c9 c9 fit
    c9 c9 fit says:

    Excellent beat ! I wish to apprentice while you amend your web site, how could i subscribe for a blog website? The account aided me a acceptable deal. I had been tiny bit acquainted of this your broadcast offered bright clear concept

    Reply
  38. bank account hacker
    bank account hacker says:

    Howdy! Someone in my Myspace group shared this site with us so I came to take a look. I’m definitely loving the information. I’m bookmarking and will be tweeting this to my followers! Fantastic blog and excellent design.

    Reply
  39. Marsuki
    Marsuki says:

    Thanx for the effort, keep up the good work Great work, I am going to start a small Blog Engine course work using your site I hope you enjoy blogging with the popular BlogEngine.net.Thethoughts you express are really awesome. Hope you will right some more posts.

    Reply
  40. western union hacker
    western union hacker says:

    Thank you for some other magnificent article. Where else may anybody get that kind of information in such an ideal manner of writing? I’ve a presentation subsequent week, and I am on the look for such info.

    Reply
  41. jasa pengiriman barang
    jasa pengiriman barang says:

    I?¦m no longer positive where you are getting your information, however great topic. I must spend a while studying more or working out more. Thank you for excellent information I used to be searching for this info for my mission.

    Reply
  42. wisata kuliner jakarta
    wisata kuliner jakarta says:

    Can I simply say what a relief to search out someone who truly is aware of what theyre speaking about on the internet. You positively know how one can deliver a difficulty to mild and make it important. More people have to learn this and perceive this side of the story. I cant consider youre no more standard because you undoubtedly have the gift.

    Reply
  43. linkslot99
    linkslot99 says:

    A formidable share, I simply given this onto a colleague who was doing a bit of analysis on this. And he in fact bought me breakfast as a result of I found it for him.. smile. So let me reword that: Thnx for the deal with! But yeah Thnkx for spending the time to discuss this, I really feel strongly about it and love reading extra on this topic. If possible, as you become experience, would you mind updating your blog with extra details? It’s extremely helpful for me. Big thumb up for this weblog put up!

    Reply
  44. kampus unggulan
    kampus unggulan says:

    It is in reality a great and useful piece of information. I am satisfied that you simply shared this helpful info with us. Please keep us up to date like this. Thank you for sharing.

    Reply
  45. jasa backlink
    jasa backlink says:

    you’re in reality a good webmaster. The web site loading speed is amazing. It kind of feels that you’re doing any unique trick. Furthermore, The contents are masterpiece. you’ve performed a wonderful job on this subject!

    Reply
  46. upn jatim
    upn jatim says:

    There are actually a whole lot of particulars like that to take into consideration. That may be a nice level to convey up. I offer the ideas above as basic inspiration but clearly there are questions like the one you convey up the place crucial thing shall be working in sincere good faith. I don?t know if finest practices have emerged around things like that, but I am sure that your job is clearly recognized as a fair game. Each girls and boys really feel the affect of just a second’s pleasure, for the rest of their lives.

    Reply
  47. mega888
    mega888 says:

    Im now not sure where you’re getting your info, but good topic. I must spend some time studying more or working out more. Thanks for fantastic information I used to be looking for this info for my mission.

    Reply
  48. Sultan88
    Sultan88 says:

    you are really a good webmaster. The web site loading speed is incredible. It seems that you’re doing any unique trick. Also, The contents are masterpiece. you’ve done a excellent job on this topic!

    Reply
  49. mega888
    mega888 says:

    Hello my friend! I wish to say that this post is amazing, great written and come with almost all vital infos. I?¦d like to peer extra posts like this .

    Reply
  50. mega888 download
    mega888 download says:

    I will immediately grasp your rss as I can not find your email subscription link or e-newsletter service. Do you have any? Please permit me realize so that I may just subscribe. Thanks.

    Reply
  51. login casino new zealand
    login casino new zealand says:

    I just like the valuable info you supply in your articles. I’ll bookmark your blog and take a look at again right here frequently. I’m fairly certain I’ll learn a lot of new stuff proper here! Best of luck for the following!|

    Reply
  52. Social Media Managemen
    Social Media Managemen says:

    you’re actually a just right webmaster. The web site loading velocity is incredible. It sort of feels that you are doing any distinctive trick. In addition, The contents are masterwork. you have done a fantastic activity in this matter!

    Reply
  53. https://www.lestarigo.com
    https://www.lestarigo.com says:

    Hi there! This is kind of off topic but I need some help from an established blog. Is it very hard to set up your own blog? I’m not very techincal but I can figure things out pretty quick. I’m thinking about creating my own but I’m not sure where to begin. Do you have any points or suggestions? Cheers

    Reply
  54. genuine hackers for hire
    genuine hackers for hire says:

    Hello there! Do you know if they make any plugins to help with SEO? I’m trying to get my blog to rank for some targeted keywords but I’m not seeing very good success. If you know of any please share. Thanks!

    Reply

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published.