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 PVSS14. Physician and Self-Referral Patient Patterns for Thoracic Outlet Syndrome Are Excellent

​Kendall Likes, Danielle Rochlin, Quinn Salditch, Thadeus Dapash, Yen Baker, Roxanne DeGuzman, Julie A. Freischlag
Johns Hopkins Medical Institutions, Baltimore, MD.

OBJECTIVES: The purpose of this study was to categorize patients referred to a specialized thoracic outlet syndrome (TOS) practice.

METHODS: Demographic and clinical data on all patients who were referred for TOS between 2006-2010 were retrospectively reviewed from a prospectively maintained, IRB approved database and patient records.
RESULTS: Between 2006-2010, 621 patients were referred for TOS (433F/188M; mean age 39 years (Range 10-87)). Five hundred seventy-one (92%) were diagnosed with TOS- 421 (74%) neurogenic, 126 (22%) venous and 24 (4%) arterial. 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 (64%) were initially treated with TOS specific physical therapy (PT) and 100 (37%) improved. One hundred seventy-eight (42%) underwent a lidocaine block and 145 (81%) had a positive block. 74 (18%) patients underwent botox injections - 44 (60%) were positive and the average number of botox injections was 1.3. One hundred forty (33%) underwent First Rib Resection and Scalenectomy (FRRS) and 128 (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 lidocaine 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 was 13 months (Range 1 week to 49 months).
CONCLUSIONS: Both referring physicians and patients are very accurate in their preliminary diagnosis of TOS- neurogenic, venous or arterial. In a specialized TOS practice, 2/3 of patients are sent to TOS specific PT and 1/3 improve from that alone. One-third of patients referred for NTOS eventually undergo FRRS with a 91% success rate.
AUTHOR DISCLOSURES: Y. Baker: Nothing to disclose; T. Dapash: Nothing to disclose; R. DeGuzman: Nothing to disclose; J. A. Freischlag: Nothing to disclose; K. Likes: Nothing to disclose; D. Rochlin: Nothing to disclose; Q. Salditch: Nothing to disclose.
Posted April 2013

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