Supraclavicular decompression was associated with substantial functional improvement in selected patients with persistent post-traumatic neurogenic thoracic outlet syndrome, though cervical rib presence may be associated with recurrence and less favorable functional recovery.
Key Findings
Results
Supraclavicular thoracic outlet decompression was associated with substantial functional improvement as measured by the DASH score.
Mean DASH score decreased from 54.8 ± 9.0 preoperatively to 9.8 ± 6.0 postoperatively (p < 0.001)
400 consecutive patients were included in the retrospective cohort study
Follow-up duration ranged from 24 to 60 months
All patients underwent first-rib resection with anterior and middle scalenectomy and excision of associated anomalous osseous structures when present
Results
A substantial proportion of patients developed recurrence during the follow-up period.
120 patients (30.0%) developed recurrence during follow-up
Recurrence-free survival was evaluated using Kaplan-Meier analysis
Multivariable regression was used to identify factors associated with recurrence
Follow-up duration ranged from 24 to 60 months
Results
Cervical rib was associated with increased odds of recurrence and less functional improvement after surgery.
Cervical rib was associated with increased recurrence (odds ratio: 1.50, 95% confidence interval: 1.05–2.10; p = 0.02)
Cervical rib was associated with less functional improvement (β = -2.1; p = 0.04)
Cervical ribs were present in 37.0% of study participants
Elongated transverse processes were present in 30.8% of study participants
Results
The patient population was predominantly female and relatively young, with multiple trauma mechanisms represented.
Mean participant age was 36.1 ± 9.5 years
255 patients (63.7%) were women
Principal trauma mechanisms included falls from height (27.3%), physical assault (26.0%), pedestrian injury (24.8%), and road traffic accidents (22.0%)
The study was conducted between 2007 and 2024 in what the authors describe as a high-trauma and resource-limited setting
Results
The surgical complication rate was low, with no major neural or vascular injuries or perioperative deaths recorded.
Pneumothorax requiring chest-tube drainage occurred in 2.0% of patients
No major neural or vascular injuries were recorded
No perioperative deaths were recorded
Patients with arterial or venous thoracic outlet syndrome were excluded from the study
What This Means
This research examined outcomes in 400 patients who developed a nerve compression condition in the shoulder and neck area (neurogenic thoracic outlet syndrome) as a result of trauma, and who were treated with surgery to relieve the compression. The patients were followed for 2 to 5 years after surgery. The study found that surgery led to a dramatic improvement in arm and shoulder function, with disability scores dropping from an average of about 55 (out of 100, where higher is worse) before surgery to about 10 afterward. The surgery also had a low rate of serious complications, with no deaths or major nerve or blood vessel injuries recorded.
However, the study also found that about 30% of patients experienced a return of symptoms during follow-up. Patients who had an extra bone called a cervical rib — present in about 37% of participants — were more likely to have their symptoms come back and showed less improvement in function overall, even though the cervical rib was removed as part of the surgery when present. The most common causes of the initial injury were falls from height, physical assault, pedestrian injuries, and road traffic accidents, and the majority of patients were women in their mid-thirties.
This research suggests that surgery can be an effective treatment for this underdiagnosed condition, particularly in trauma settings, but that patients with certain anatomical features like cervical ribs may need closer monitoring for recurrence. The authors note that the study was conducted at a single center and call for larger, prospective multicenter studies to confirm these findings and better understand which patients are most likely to benefit from surgery.
Rasul M, Wahab B, Abdalla A, Baram A. (2026). Post-traumatic neurogenic thoracic outlet syndrome: Clinical presentation and surgical outcomes-A retrospective cohort study.. The Journal of international medical research. https://doi.org/10.1177/03000605261488728