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- Volume 83,Issue Suppl 1
- AB0373 CHARACTERISTICS AND LONG-TERM EVOLUTION OF THORACIC OUTLET SYNDROME: CASE SERIES OF PATIENTS AT A LEBANESE OUTPATIENT CLINIC
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Osteoarthritis and other mechanical musculoskeletal problems
AB0373 CHARACTERISTICS AND LONG-TERM EVOLUTION OF THORACIC OUTLET SYNDROME: CASE SERIES OF PATIENTS AT A LEBANESE OUTPATIENT CLINIC
- K. Eid1,
- L. Karam2,
- O. Aitisha Tabesh2,
- R. Faddoul3,
- F. Fayad4
- 1Hôtel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon
- 2Hôtel-Dieu de France University Hospital, Saint-Joseph University, Rheumatology Department, Beirut, Lebanon
- 3Saint Joseph University, Faculty of engineering, Beirut, Lebanon
- 4Lebanese Hospital Geitaoui-UMC, Lebanese University, Beirut, Lebanon, Rheumatology Department, Beirut, Lebanon
Abstract
Background: Thoracic outlet syndrome (TOS) has been considered an uncommon condition. The literature regarding the long-term evolution of TOS remains very limited by the small number of patients in published studies and/or the short duration of follow-up. In addition, most studies excluded patients managed with a conservative treatment [1]. However, TOS is a chronic condition, most often affecting young patients, and is rarely treated with surgery. It is therefore important to evaluate the long-term prognosis of patients with TOS and to analyze the parameters that would be associated with a good outcome.
Objectives: To assess the characteristics and the long-term evolution of TOS and to identify the predictive factors of a favorable outcome.
Methods: Patients with TOS, diagnosed between January 2010 and December 2017 were included in this study. The exclusion criteria were rigorous to guarantee the hom*ogeneity of the population studied. Patients suffering from TOS associated with fibromyalgia or any disease affecting the cervical spine, the shoulder girdle, or the upper limbs, were excluded. Demographic, clinical and imaging data were collected from electronic medical records. The evaluation of long-term evolution was completed by phone interviews, based on patient self-assessment, with an overall improvement of at least 50% (from diagnosis to the phone call assessment) being considered as clinically relevant.
Results: A total of 96 patients with TOS are included. The mean age at diagnosis was 34.9 ± 9.1 years (range, 18 to 61 years). Most patients (91.7%) were women. 35 patients have a pure neurologic TOS while 61 have neurologic and vascular TOS. Most patients were treated conservatively. Ninety (93.7%) patients had physical therapy, combined with analgesics and muscle relaxants in 30 cases. Only 9 patients needed surgery (4 for resection of cervical rib and 5 for resection of first rib).
The mean duration of follow-up was 9.9 ± 2,4 years. The mean percentage of overall improvement of patients was 69.6 ± 21.5%. 59 patients (61.5%) reported an overall improvement of at least 50%. The presence of Droopy Shoulder Syndrome (DSS) is correlated with a favorable outcome in 76.7% of cases (P =0.03). Patients suffering from pure neurologic TOS were numerically more commonly improved by conservative treatment without resorting to surgery. High rates of return to work and leisure activities were observed after conservative treatment. Among 27 patients who had to leave their professional activity due to TOS, 23 managed to return to work. Similarly, among 28 patients who had to stop their leisure activities, 23 were able to resume.
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Conclusion: This study highlights the very good long-term outcome of TOS after conservative treatment, underlining the critical importance of recognizing specific features such as DSS. Conservative management of TOS can be sufficient in most cases to significantly improve the quality of life of patients without the need of surgery.
REFERENCES: [1] Peek J, Vos CG, Ünlü Ç, Schreve MA, Van de Mortel RHW, De Vries JPPM. Long-Term Functional Outcome of Surgical Treatment for Thoracic Outlet Syndrome. Diagnostics. 2018;8(1):7.
Acknowledgements: NIL.
Disclosure of Interests: None declared.
- Physical therapy/Physiotherapy
- Bone
- Pain
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- Physical therapy/Physiotherapy
- Bone
- Pain
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