Monday, December 26, 2011

Thoracic Outlet Syndrome After Motor Vehicle Accidents

Thoracic Outlet Syndrome After Motor Vehicle Accidents

                Thoracicoutlet syndrome (TOS) is a recognized sequelae of motor vehicle accidents (MVAs) in general, and whiplash injuries in particular. In 1977, Capistrant described 35 cases of TOS induced by trauma, 80% of which were whiplash injuries. Moore, in 1986, found that 33% of whiplash injury patients reported arm symptoms which he related to TOS. Sanders found that of 668 patients operated on for TOS, 32% had been involved in a rear-end accident and 25% had been in a side or head-on collision.

                Now, a new study adds to the body of knowledge of whiplash-induced TOS. In this report, 90 patients who had been sent to a Canadian pain clinic were diagnosed with TOS. Of these 90 patients, 32 (35.6%) has TOS associated with an MVA. The mean symptom duration at the time of the study was 37 months. 

                One half of the patients were chosen (not randomly selected) for surgery, the other half for conservation treatment. Only 7 of 15 (47%) of the surgical patients had “very good to excellent” results, and 3 of these patients later had recurrence of symptoms. In short, only 4 of 15 patients (26.6%) had good results from surgery. Six patients had reoperation, and only one of these had positive results.

                In the conservative management group, 3/15 (20%) had “very good to excellent” results, and 3/15 (20%) had modest pain relief. 60% had no pain relief.

                Surgical findings: “…13/15 patients (87%) were found to have primarily muscultendinous anomalies in the form of tight bands or thick muscle attachments.” This is consistent with reports by Sanders regarding fibrous bands in the scaleness in these patients.

                The low rate of surgical success in the treatment of TOS has been discussed by others, including Lindgren and Oksala, who suggested that surgical success may simply by placebo.

                One very important finding of this study was that 67% of the TOS symptoms were on the side of the driver’s shoulder strap, suggesting that the force of the body against the shoulder restraint during whiplash may be responsible for some TOS problems.


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