PMID- 29401331 OWN - NLM STAT- MEDLINE DCOM- 20190322 LR - 20190322 IS - 1930-613X (Electronic) IS - 0026-4075 (Linking) VI - 183 IP - 1-2 DP - 2018 Jan 1 TI - Supraclavicular Thoracic Outlet Decompression in the High-Performance Military Population. PG - e90-e94 LID - 10.1093/milmed/usx010 [doi] AB - BACKGROUND: Neurogenic thoracic outlet syndrome (nTOS) is a relatively common disorder and often affects younger, physically active populations. The modern American military is a population at risk for the development of nTOS given the intense physical training requirements. The purpose of this study is to determine functional recovery in the active duty military population resulting in full, unrestricted return-to-duty status following supraclavicular thoracic outlet decompression with partial first rib resection, partial anterior scalenectomy, and brachial plexus neurolysis. METHODS: This retrospective study was approved by the Institutional Review Board at Walter Reed National Military Medical Center, Bethesda, Maryland to evaluate functional recovery following the surgery management of nTOS. In accordance with the Walter Reed National Military Medical Center Institutional Review Board, patient informed consent was obtained for this study. An institutional procedural database (Walter Reed National Military Medical Center Surgery Scheduling System) was queried for consecutive patients who underwent supraclavicular thoracic outlet decompression from January 2011 to May 2015. This study involved the completion of two survey instruments: the Disabilities of the Arm, Shoulder, and Hand survey and the Cervical Brachial Symptoms Questionnaire. Patients were asked to complete the preoperative surveys and the postoperative surveys. RESULTS: Twenty responses were obtained with a 57% (20/35) overall response rate. Due to the low sample size, results were reported as a median rather than a mean to reduce the bias of outliers. Of the 20 patients who underwent supraclavicular thoracic outlet decompression, 85% reported improved functional recovery, 10% demonstrated no improvement but maintained stable functional and symptomatic deficits, and 5% demonstrated worsening of their functional and symptomatic status. The median total preoperative Disabilities of the Arm, Shoulder, and Hand score was calculated at 112 (interquartile range [IQR] 94-122) with an overall score reduction demonstrated by the median total postoperative Disabilities of the Arm, Shoulder, and Hand score of 50 (IQR 40-71). The median total score reduction of 57 (IQR 28.5-72) represented improved clinical and functional recovery (p < 0.001). The median total preoperative Cervical Brachial Symptoms Questionnaire score was 96 (IQR 74-111) with an overall score reduction revealed by the median total postoperative Cervical Brachial Symptoms Questionnaire score of 28 (IQR 19-45). The median total score reduction of 60 (IQR 23-77) reflected significant functional recovery consistent with clinical improvement (p < 0.001). Around 89% of patients had a predecompression temporary profile secondary to physical debilitation directly related to nTOS. Following surgery, temporary profile status was reduced to 39%. Around 61% of patients were able to complete and pass their service-specific physical fitness testing. Around 56% of patients demonstrated a full return-to-duty status without limitations. CONCLUSION: Supraclavicular partial first rib resection, partial anterior scalenectomy, and brachial plexus neurolysis results in significant improvement in functional recovery in the military active duty patient population. Prospective studies are warranted to further characterize and define nTOS functional recovery after surgery in this population. CI - Published by Oxford University Press on behalf of Association of Military Surgeons of the United States 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US. FAU - White, Joseph M AU - White JM AD - Division of Vascular Surgery, The Department of Surgery at Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889. FAU - Soo Hoo, Andrew J AU - Soo Hoo AJ AD - Division of Vascular Surgery, The Department of Surgery at Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889. FAU - Golarz, Scott R AU - Golarz SR AD - Division of Vascular Surgery, Temple University Hospital, 8025 Castor Avenue, Philadelphia, PA 19152. LA - eng PT - Journal Article PL - England TA - Mil Med JT - Military medicine JID - 2984771R SB - IM MH - Adult MH - Athletes/statistics & numerical data MH - Decompression, Surgical/methods/*standards MH - Female MH - Humans MH - Male MH - Maryland/epidemiology MH - Middle Aged MH - Military Personnel/statistics & numerical data MH - Prospective Studies MH - Retrospective Studies MH - Surveys and Questionnaires MH - Thoracic Outlet Syndrome/epidemiology/*surgery MH - *Treatment Outcome EDAT- 2018/02/06 06:00 MHDA- 2019/03/23 06:00 CRDT- 2018/02/06 06:00 PHST- 2017/03/14 00:00 [received] PHST- 2018/02/06 06:00 [entrez] PHST- 2018/02/06 06:00 [pubmed] PHST- 2019/03/23 06:00 [medline] AID - 4665411 [pii] AID - 10.1093/milmed/usx010 [doi] PST - ppublish SO - Mil Med. 2018 Jan 1;183(1-2):e90-e94. doi: 10.1093/milmed/usx010.