Supraclavicular decompression for neurogenic thoracic outlet syndrome; an individually tailored approach

ABSTRACT

The objective of this study was to evaluate the clinical outcome of supraclavicular decompression for thoracic outlet syndrome, and whether first rib resection is needed in all cases. 51 patients underwent 58 procedures, 7 being bilateral. There were 48 females and 3 males. The mean age was 26 years. 88% had lower plexus symptoms, and 5% had a motor deficit. The most sensitive provocative test was the plexus compression test [95%]. Through a supraclavicular approach, the plexus was explored, and the compressing agents resected. Intraoperative dynamic assessment of the plexus was an important part of the procedure. Using the Balci et al, staging system, 90% obtained a good to excellent result at latest follow up. Minimal complications were encountered in this series. In conclusion, the supraclavicular approach affords an excellent exposure of the plexus elements and its compressing agents, and allows dealing with them successfully. The extent of the decompression is individually assessed based upon the patient symptoms, the provocative positioning aggravating his symptoms, the operative findings and the intraoperative dynamic assessment of the plexus including provocative tests, and longitudinal traction of the arm. The final aim should be a plexus free of compression