Post-Traumatic Thoracic Outlet Syndromes

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This retrospective study aims to clarify the mechanisms, frequency, symptoms, treatment, and outcome of post-traumatic thoracic outlet syndromes. A total of 13 patients (7 men and 6 women) with a mean age of 41 ± 16 years were studied. Underlying injuries resulted from sports, road, and household accidents. Bone lesions were pseudarthrosis, hypertrophic callus, and luxations. Congenital anomalies were observed in five patients (38%). Vascular lesions included aneurysm of the subclavian artery or vein, acute ischemia, and subclavian vein thrombosis. Operative treatment involving orthopedic and/or vascular surgery was indicated in all patients. Post-traumatic thoracic outlet syndrome occurs in young subjects after violent trauma. Vascular complications are frequent and severe. Treatment achieves good results but benefits may be diminished by bone or nerve involvement.

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INTRODUCTION

Thoracic outlet syndrome (TOS) has been reported since antiquity. Operative treatment with rib resection was described first through a supraclavicular approach in 1905 and then through a transaxillary approach in 1966.1, 2 The frequency of TOS is low. Symptoms result from compression of the brachial plexus and subclavian vascular structures. Neurological symptoms with pain and numbness are usually most prominent. Vascular signs are less common.3, 4, 5 Arterial compression can cause extrinsic

PATIENTS AND METHODS

This study includes a consecutive series of patients hospitalized in the vascular surgery departments of the Purpan University Hospital in Toulouse, France, and Pellegrin University Hospital in Bordeaux, France, for assessment or diagnosis of posttraumatic TOS between 1987 and 2002. A requirement for inclusion in this study was the presence of acquired bone lesions documented by plain radiography and/or computed tomography (CT).

Thirteen patients had the previously mentioned criteria. In some

RESULTS

This series includes 13 patients. There were seven men (54%) and six women (46%) with a mean age of 41 ± 16 years (Table I). These 13 patients accounted for less than 5% of the overall population treated for TOS during the same time period.

All patients were examined after the initial trauma period. The interval between the trauma event and management in the Vascular Surgery Department ranged from 1 month to 15 years. Most cases involved high-energy trauma, resulting from sports-related

DISCUSSION

TOS is rare. Trauma-related cases are still uncommon but represent a special form requiring specific therapeutic management. The objectives of clinical examination are to document previous trauma, confirm diagnosis of TOS by classic postural maneuvers, and detect complications such as distal ischemic signs, edema, and cyanosis of the upper extremity. For assessment of bone lesions, plain radiography can visualize pseudarthrosis, hypertrophic callus of the clavicle or first rib, and

CONCLUSIONS

Because the incidence of post-traumatic TOS is low, management is rarely required. However, surgeons should be aware of the special features of this entity. In this regard, the high incidence and severity of vascular lesions must be underscored, with special emphasis on the frequent association between pseudarthrosis of the clavicle and subclavian artery aneurysm. Subclavian artery aneurysm should be searched for in all patients with TOS in association with pseudarthrosis. Patients having

REFERENCES (14)

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Presented at the Eighteenth Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, Toulouse, France, May 21–24, 2003.

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