Diagnostic Accuracy of Physician and Self-referred Patients for Thoracic Outlet Syndrome are Excellent

The purpose of this study was to categorize patients referred to a specializedthoracic outlet syndrome (TOS) practice to determine the diagnostic accuracy of those who are physician and self-referred.

METHODS:

Demographic and clinical data on all patients who were referred for TOS between 2006 and 2010 were retrospectively reviewed from a prospectively maintained, IRB-approved database and patient records.

RESULTS:

Between 2006 and 2010, 621 patients were referred for TOS (433F/188M; mean age 39 years (range 10-87)). Five hundred seventy-one patients (92%) were diagnosed with TOS, with 421 (74%) neurogenic, 126 (22%) venous, and 24 (4%) arterial TOS cases. Of the 525 physician referrals, 478 (91%) had TOS and of the 93 self-referrals, 90 (97%) had TOS. The 421 patients with neurogenic TOS (NTOS) (304F/117M) had symptoms on average for 56 months (range 1-516). Two hundred seventy-one patients (64%) were initially treated with TOS-specific physical therapy (PT), and 100 (37%) improved. One hundred seventy-eight patients (42%) underwent a lidocaine block and 145 patients (81%) had a positive block. 74 patients (18%) underwent botox injections; 44 (60%) were positive and the average number of botox injections was 1.3. One hundred forty patients (33%) underwent transaxillary first rib resection and scalenectomy (FRRS) and 128 patients (91%) improved. Of patients undergoing FRRS, 92 (66%) had a lidocaine block, 82 (89%) of which were positive. Of patients with a positive lidocaine block, 74 (90%) improved following FRRS. Of patients undergoing FRRS, 31 (22%) underwent botox injections, 15 (48%) of which were positive. Of patients with a positive Botox block, 14 (93%) improved following FRRS. Average length of time between initial visit and operation was 6.4 months (range 2 weeks to 34 months) and average follow-up time was 13 months (range 1 week to 49 months).

CONCLUSIONS:

1. Both referring physicians and patients are very accurate in their preliminary diagnosis of TOS (neurogenic, venous or arterial). 2. In a specialized TOS practice, two-thirds of patients are sent to TOS-specific PT and one-third improve from this treatment alone. 3. One-third of patients referred for NTOS eventually undergo FRRS with a 91% success rate.

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