The Second Time Around: Re-Intervention Following Surgical Treatment in Patients with Thoracic Outlet Syndrome

Objective: Patients with TOS benefit from surgical intervention. Some patients present with residual, recurrent or contralateral symptoms following the initial operation. The purpose of this study was to report these patients’ management and outcomes.
Methods: Data was prospectively collected from 08/03-07/08. Upon retrospective review, 34/185 patients had residual, recurrent or contralateral symptoms.
Results:
Group 1: Residual Symptoms (n=8)
4 patients had an incomplete rib resection; 1 patient had a residual portion of the cervical rib fused to the first rib, and 3 patients had undergone scalenectomy only. All patients underwent a transaxillary first rib resection at 89.1 months (19-408 months) following their initial surgeries. 5/8 improved.
Group 2: Recurrent Symptoms (n=9)
9 patients presented with symptoms secondary to scar tissue. All were treated initially with physical therapy but required botox injections at 21.4 months (10-36 months) postoperatively. 2 required re-injection and all 9 patients improved.
Group 3: Contralateral Symptoms (n=17)
7 neurogenic patients with contralateral symptoms underwent transaxillary first rib resection with scalenectomy (FRRS) at 14.2 months following the initial FRRS. 2 improved and were significantly younger (22 and 27 years of age). Those who did not improve were older (mean age 44.8 years) and had depression, fibromyalgia, and/or myofasciitis. 10 patients had either contralateral venous compression (8) or thrombosis (2) and underwent FRRS. All 10 improved.
Conclusion: Successful treatment for patients with residual, recurrent or contralateral symptoms depends upon the etiology. Treatment modalities include re-operation, physical therapy, botox injections, or a combination thereof. Patients with other morbidities may not improve. Initial surgical treatment for TOS should include complete first rib and/or cervical rib resection with scalenectomy to prevent the need for reoperation.