THORACIC OUTLET SYNDROME: MANAGEMENT AND OUTCOME

Abstract

Objective:To evaluate the results of cervical rib excision or scalenotomy to relieve the symptoms of thoracic outlet syndrome without excision of the first rib through supraclavicular surgical approach.Design:Retrospective observational descriptive study.Place and duration:Department of Thoracic Surgery Postgraduate Medical Institute, Govt: Lady Reading Hospital Peshawar from July 2003 to June 2007.Material and Methods:Detail scrutiny of the clinical record of patients who underwent cervical rib excision or scalenotomy through supraclavicular approach was carried out. The results of the procedure were analyzed in terms of clinical improvement in the symptoms of TOS. Negativity of the clinical tests were noted which were positive pre operatively. The usefulness of the supraclavicular approach for the excision of cervical rib or scalenotom without excision of the first rib was also noted.Results:A total of 30 patients underwent the procedure during the last 4 years. 19(63.3%) patients underwent cervical rib excision and 11(36.6%} patients had scalenotomy. The minimum follow up was 6 month. At 3 months follow up, 21(70%) of patients had complete resolution of the symptoms with return to normal routine work. 5(16.6%) patients had moderate improvement in their symptoms with more decrease in pain and need for medication. One patient had little improvement. At 6 months follow up no recurrence of symptoms had occurred. 3 patients lost to follow up including one with bilateral disease.3(10%) post operative complications occurred. One had haematoma in the wound which responded to local drainage while 2 patients had minor wound infections which were treated conservatively. There was no mortality.Conclusion:Cervical rib excision or scalenotomy is sufficient to relieve the symptoms of TOS without excision of the first rib. Supraclavicular incision is an easy and appropriate approach to excision of cervical rib or scalenotomy.