Patient-Reported Outcomes from Supraclavicular Thoracic Outlet Decompression.

Purpose: The diagnosis of neurogenic thoracic outlet syndrome is based on patient history, provocative maneuvers, and, ultimately, the successful relief of symptoms following surgical decompression. We sought to understand patient-reported outcomes after thoracic outlet decompression. Methods: All patients undergoing thoracic outlet decompression between July 2015 and July 2020 were identified from a single institutional database. Validated questionnaires including, Thoracic Outlet Syndrome Index, Short Form 20, Pain Catastrophizing Scale (PCS), Zung Self-Reporting Depression Scale, and nine of our own questions, were used to report patient outcomes from 10 individuals. Results: The Thoracic Outlet Syndrome Index, Zung Self-Reporting Depression Scale, Short Form 20 pain subscore, and PCS averages were 63 (± 44.3), 58.25 (± 5.04), 40.3 (± 17.5), and 22.6 (± 18.81), respectively. One hundred percent of patients indicated some level of depression with 50% indicating mild levels and 50% indicating moderate levels of depression. Pain was the most commonly reported improved symptom after surgery with 50% indicating a ≥95% improvement. Despite 80% of patients indicating surgery provided the results they were expecting, 60% still had some element of numbness in their arm or hand. Conclusions: Thoracic outlet decompression can produce high levels of symptom improvement, especially in regards to pain. Lack of improvement can be related to a multitude of factors including confounding depression, pain catastrophizing/neurosis, inaccurate diagnosis of thoracic outlet syndrome, or double crush syndrome. More objective tests for identifying thoracic outlet syndrome may help to better understand which patients have a better likelihood of symptom improvement after surgery. Type of study/level of evidence: Symptom Prevalence Study III.