Thoracic outlet syndrome: Presentation and management

Background : Thoracic outlet syndrome (TOS) is the most confusing and controversial subject; its treatment continues to be a dilemma. The symptoms are due to the neurovascular compression at the thoracic outlet.
Aims : The objective of the study was to review our experience with this problem with particular reference to its presentation and management.
Settings and Design: A retrospective analysis.
Materials and Methods : Seventy-two patients (age range 15-55 years), treated for neurovascular complications of TOS from 1991 to 2005. Evaluation included clinical and radiological examinations comprising of radiograph, color duplex and angiogram with positional maneuvers.
Result : Nineteen patients had features of neurogenic TOS, whereas 52 patients presented with arterial TOS. One case was found to have venous TOS. The diagnosis was based on the characteristic history and positive provocative tests. Cervical ribs were seen in 58 cases. Angiogram was performed in all arterial TOS. Conservative treatment offered 74% (14) good results in neurogenic cases. Scalenectomy with cervical rib excision via supraclavicular approach, with or without vascular reconstruction, was done in 46 cases. There was no major complication and 90% (42) cases showed good results.
Conclusion : TOS is not an uncommon disorder and often goes undiagnosed. Conservative treatment plays a vital role in neurogenic TOS. In our experience, scalenectomy with cervical rib excision via supraclavicular approach gives good and lasting results with an acceptable outcome and minimum morbidity.