American Society for Peripheral Nerve

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Thoracic Outlet: A Critical Analysis
Allan J. Belzberg, MD; Michael J. Dorsi, MD; Bo Povlsen; Thomas Hansson
Johns Hopkins University, Baltimore, MD, USA

The term Thoracic Outlet Syndrome (TOS) refers to a variety of disorders, each with their respective treatments. The purpose of this systematic review was to evaluate the beneficial and adverse effects of the available operative and non-operative interventions for the treatment of TOS.

We searched the Cochrane Neuromuscular Disease Group Trials Specialized Register (July 2009), The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2009), MEDLINE (January 1966 to June 2009), EMBASE (January 1980 to June 2009), CINAHL (January 1981 to June 2009 ), AMED (January 1985 to June 2009 ) and reference lists of articles. Randomized or quasi-randomized studies of participants with the diagnosis of any type of TOS (neurogenic, vascular, or 'disputed') were eligible for inclusion. The primary outcome measure was change in pain rating on a validated visual analog or similar scale at least six months after the intervention. The secondary outcomes were change in muscle strength and adverse effects of the interventions.

This review was complicated by a lack of generally accepted diagnostic criteria for the diagnosis of TOS. There was very low quality evidence that transaxillary first rib resection decreased pain more than supraclavicular neuroplasty; however, there is no randomized evidence that either is better than no treatment. There is no randomized evidence to support the use of other currently used treatments. There is a need for a consensus regarding the diagnostic criteria for TOS, especially the disputed form, and appropriate outcome measures to be used in this population. High quality randomized trials comparing the outcomes of various interventions to each other and to no treatment are also necessary.

This presentation will begin with a case presentation followed by a summary of the Cochrane Review.

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