Recurrent Neurogenic Thoracic Outlet Syndrome (TOS): A Systematic Review of the Literature
Abstract
Introduction
Thoracic outlet syndrome (TOS) is a set of symptoms that arise when neurovascular bundles are compressed in the course of passage through three spaces: the costoclavicular junction, the scalene triangle, and the pectoralis minor space. This study aims to review the literature regarding the proper management of recurrent TOS.
Methods
We conducted a systematic literature search using various databases up to December 20, 2022. The study included those articles in which the symptoms were regarded as recurrent if TOS-related symptoms like pain and/or discomfort recurred following an initial resolution of symptoms. Multiple data were gathered from the included studies, including the publication year, first author, country, sex, age, type of primary intervention, duration of physiotherapy, type of reoperation, compressing structures, and the outcome.
Results
The study included 14 articles. Two of the articles were case reports, 10 were case series, and the remaining were cohort studies. A total of 686 patients were included, of whom 506 (73.7%) were female. The ages ranged from 17 to 79 years, with varying means across the age groups. Nine out of 14 (64%) studies reported the first rib remnant as one of the causative factors in the recurrence of TOS. Excellent or good results were reported in 474 (69%) patients.
Conclusion
Recurrent TOS is a relatively common finding after primary treatment for neurogenic TOS. Management is similar to primary TOS, including conservative management and surgical intervention. The latter should not be delayed if conservative treatment fails.
References
- Gadiwalla Q, Dong S, Recarey M, Nguyen B, Lala S. Recurrent arterial and new-onset neurogenic thoracic outlet syndrome as a complication after previously inadequately excised first and cervical ribs. Journal of Vascular Surgery Cases, Innovations and Techniques. 2022 ;8(3):328-30. doi:10.1016/j.jvscit.2022.04.011
- Joseph L.Lukad. Controversies in Thoracic Outlet Syndrome. Barw Medical Journal. 2023;1(3):1. doi:10.58742/BMJ.V1I2.40
- Likes K, Dapash T, Rochlin DH, Freischlag JA. Remaining or residual first ribs are the cause of recurrent thoracic outlet syndrome. Annals of Vascular Surgery. 2014; 28(4):939-45. doi:10.1016/j.avsg.2013.12.010
- Jammeh ML, Ohman JW, Vemuri C, Abuirqeba AA, Thompson RW. Anatomically complete supraclavicular reoperation for recurrent neurogenic thoracic outlet syndrome: clinical characteristics, operative findings, and long-term outcomes. Hand. 2022; 17(6):1055-64. doi:10.1177/1558944720988079
- Sanders RJ. Recurrent neurogenic thoracic outlet syndrome stressing the importance of pectoralis minor syndrome. Vascular and endovascular surgery. 2011;45(1):33-8. doi:10.1177/1538574410388311
- Cheng SW, Stoney RJ. Supraclavicular reoperation for neurogenic thoracic outlet syndrome. Journal of vascular surgery. 1994;19(4):565-72. doi:10.1016/S0741-5214(94)70027-3
- Ambrad-Chalela E, Thomas GI, Johansen KH. Recurrent neurogenic thoracic outlet syndrome. The American journal of surgery. 2004; 187(4):505-10. doi:10.1016/j.amjsurg.2003.12.050
- Annest SJ, Melendez BA, Sanders RJ. Recurrent and residual neurogenic thoracic outlet syndrome. Thoracic Outlet Syndrome. 2021:333-40. doi:10.1007/978-3-030-55073-8_34
- Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery. 2021; 88: 105906. doi:10.1016/j.ijsu.2021.105906
- Muhialdeen AS, Ahmed JO, Baba HO, Abdullah IY, Hassan HA, Najar KA, et al. Kscien’s List; A New Strategy to Discourage Predatory Journals and Publishers (Second Version). Barw Medical Journal. 2023. doi:10.58742/BMJ.V1I1.14
- Sanders RJ, Haug CE, Pearce WH. Recurrent thoracic outlet syndrome. Journal of vascular surgery. 1990;12(4):390-400. doi:10.1016/0741-5214(90)90040-H
- Gelabert HA, Jabori S, Barleben A, Kiang S, O'Connell J, Jimenez JC, DeRubertis B, Rigberg D. Regrown first rib in patients with recurrent thoracic outlet syndrome. Annals of Vascular Surgery. 2014;28(4):933-8. doi:10.1016/j.avsg.2014.01.004
- Sessions RT. Recurrent thoracic outlet syndrome: causes and treatment. Southern Medical Journal. 1982;75(12):1453-61. doi:10.1097/00007611-198212000-00004
- Sanders RJ, Monsour JW, Gerber WF. Recurrent thoracic outlet syndrome following first rib resection. Vascular Surgery. 1979;13(5):325-30. doi:10.1177/153857447901300505
- Urschel Jr HC, Razzuk MA. The failed operation for thoracic outlet syndrome: the difficulty of diagnosis and management. The Annals of thoracic surgery. 1986;42(5):523-8. doi:10.1016/S0003-4975(10)60574-7
- Urschel Jr HC, Razzuk MA, Albers JE, Wood RE, Paulson DL. Reoperation for recurrent thoracic outlet syndrome. The Annals of Thoracic Surgery. 1976;21(1):19-25. doi:10.1016/S0003-4975(10)64882-5
- Wiley AP, Costa CG, Pothering CA, Freischlag JA. Residual first rib resection aided by partial second rib resection in the treatment of recurrent thoracic outlet syndrome. Annals of Vascular Surgery-Brief Reports and Innovations. 2022;2(3):100118. doi:10.1016/j.avsurg.2022.100118
- Greenberg JI, Alix K, Nehler MR, Johnston RJ, Brantigan CO. Computed tomography-guided reoperation for neurogenic thoracic outlet syndrome. Journal of Vascular Surgery. 2015;61(2):469-74. doi:10.1016/j.jvs.2014.07.008
- Povlsen S, Povlsen B. Diagnosing thoracic outlet syndrome: current approaches and future directions. Diagnostics. 2018;8(1):21. doi:10.3390/diagnostics8010021
- Braun RM, Shah KN, Rechnic M, Doehr S, Woods N. Quantitative assessment of scalene muscle block for the diagnosis of suspected thoracic outlet syndrome. The Journal of Hand Surgery. 2015;40(11):2255-61. doi:10.1016/j.jhsa.2015.08.015
- Martinez BD, Wiegand CS, Evans P, Gerhardinger A, Mendez J. Computer-assisted instrumentation during endoscopic transaxillary first rib resection for thoracic outlet syndrome: a safe alternate approach. Vascular. 2005;13(6):327-35. doi:10.1258/rsmvasc.13.6.327
- Suzuki T, Kimura H, Matsumura N, Iwamoto T. Surgical approaches for thoracic outlet syndrome: a review of the literature. Journal of Hand Surgery Global Online. 2022;73(6):2059-63. doi:10.1016/j.jhsg.2022.04.007
- Rochlin DH, Orlando MS, Likes KC, Jacobs C, Freischlag JA. Bilateral first rib resection and scalenectomy is effective for treatment of thoracic outlet syndrome. Journal of vascular surgery. 2014;60(1):185-90. doi:10.1016/j.jvs.2014.01.034
- Johansen K. Rib-Sparing scalenectomy for neurogenic thoracic outlet syndrome: Early results. Journal of Vascular Surgery. 2021;73(6):2059-63. doi:10.1016/j.jvs.2020.12.052
- Atasoy E. Recurrent thoracic outlet syndrome. Hand Clinics. 2004;20(1):99-105. doi:10.1016/S0749-0712(03)00085-4
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