Consecutive case series.
Our aim was to evaluate the outcomes of patients who underwent supraclavicular scalenotomy followed by external neurolysis without rib resection for post-traumatic neurogenic thoracic outlet syndrome (NTOS).
Summary of Background Data.
NTOS comprises >95% of all thoracic outlet syndrome patients, and most patients with NTOS have a history of trauma before the onset of their symptoms.
Patients treated with supraclavicular scalenotomy and neurolysis without rib resection from September 2014 to December 2019 were retrospectively reviewed by using the medical records and operative notes. Patient's characteristics, clinical symptoms before treatment, operative findings, and short- and long-term outcomes were assessed. To assess clinical outcomes at 2 months after surgery (short-term outcomes) and 12 months later (long-term outcomes), we used a four-grade categorization of patients’ subjective evaluations after surgery.
Ninety-six supraclavicular scalenotomies without rib resection were performed on patients with post-traumatic NTOS. The most common intraoperative observation was the fibrous bands within the anterior scalene muscle in 86 cases (89.6%). The short-term outcome with patients’ subjective evaluation in 96 operations at 2 months after surgery showed a 96.9% success rate (excellent + good). In 85 cases followed for >12 months after surgery, the success rate based on patients’ subjective evaluation at the last clinic follow-up appointment as a long-term outcome was 74.1%.
In post-traumatic NTOS, it has been reported the arm and hand symptoms are due to pressure on the brachial plexus, which can stem from the swollen muscle following injuries and later from tightness of the scarred muscle. Considering this mechanism and our results, we concluded that supraclavicular scalenotomy and external neurolysis without rib resection made sense, as they were very effective and adequate to improve symptoms of NTOS.
Level of Evidence: 5