New Study Determines Management of Patients with Neurogenic Thoracic Outlet Syndrome
Shoulder pain was the focus of a study which Dr Laura Redman presented for her Masters of Medicine degree in Surgery.
The title of her dissertation was: “Neurogenic Thoracic Outlet Syndrome: An In Depth Review”.
Neurogenic Thoracic Outlet Syndrome (TOS) is an overlooked and obscure cause of shoulder pain due to the compression of nerves or blood vessels which can occur between the neck and armpit.
‘It is a poorly defined and often sub optimally treated entity in Vascular (and General) Surgery,’ said Redman. ‘There is no specific cause for the condition, only numerous risk factors, and there is no single investigation that confirms these diagnoses. Treatment for this condition has evolved for over a century with multiple treatment options still being described for TOS patients.’
Redman says her study analysed risk factors, patient profiles and specifically, what investigations would actually contribute to the management of TOS patients. Records of 219 patients who had been submitted to surgery over a 10-year period (1999-2009) were reviewed from a database while a sub study was done on patients operated on over the past four years for whom details of the intra-operative anatomical findings were meticulously recorded.
‘What was really noteworthy was the finding that at surgery almost all the TOS patients had some anatomical abnormality within the brachial plexus.’ The brachial plexus is a network of nerve fibres which conduct signals from the spinal cord.
‘The majority of these anomalies involve the configuration of the brachial plexus. We strongly recommend that the supraclavicular approach be used in order to define anatomical aberrations. This finding is interesting as it may as well be an important contributing factor to the pathology in most cases,’ said Redman.
The findings notably suggested an essential, identifiable anatomical cause for the patient’s symptoms. Redman’s research has also allowed her to suggest ‘the best surgical approach - supraclavicular rather than axillary - as these abnormalities can be identified through this incision and the nerve trunks released and freed which will aid in symptom resolution’.
Redman is a Vascular Surgeon currently working in Cape Town in private practice, having specialised in general surgery with a subspecialty in vascular surgery.
Redman, who wants to continue with vascular research, enjoys playing the piano, sketching, doing sculptures, running and swimming when she has time.- Zakia Jeewa