Studies have shown that TOS is common in
females. The male/female ratio (MFR) has been
reported to be between 1/3 and 1/9 in case series.[
1,
4]
In our study, this ratio was 1/3. The MFR is also
preserved in bilaterally operated cases. In this study,
the MFR was found to be compatible with the
literature.
The most common period with TOS is the third
decade of life, which coincides with the period when
patients' physical activities are most intense.[1,9] The
mean age of the patients operated on in our clinic
was 36.2±11.7 years. When distribution was made
according to age groups, the ratio of cases between
the ages of 20 and 39 to all patients was 87.5%. The
mean age of the patients in our study and the fact
that the majority of the cases were between the ages
of 20 and 39 are compatible with the literature.
It is accepted that TOS may develop due to
excessive tension in the upper extremities and neck
area, load on the neck area, shoulder muscle and
scalene muscle hypertrophy due to the constant use
of the upper extremities in the same position, and
chronic trauma during work done with the upper
extremities, depending on working conditions.
Thoracic outlet syndrome findings are more common
in occupational groups such as construction workers,
secretaries, and computer operators, who work
with repetitive movements of the upper extremity
with support from the arms, compared to other
occupational groups.[10] In a study conducted in
Türkiye, female patients (housewives) who did not
work in any job constituted 51.4% of the etiology of
TOS.[11] In this study, it was determined that 43.8%
of the cases were housewives.
In EMG studies, it has been shown that the
UNCV value is higher in postoperative measurements
compared to preoperative measurements and is above
the 60 m/sec limit.[5,10] In our study, postoperative
UNCV values were higher than preoperative
measurements, indicating that surgical decompression
eliminates nerve irritation and contributes to nerve
healing in cases where the brachial plexus is affected.
In the transaxillary approach, the surgery is
performed in a deep and narrow area. The reported
complication rate in the transaxillary region
is approximately 13 to 26%, and the incidence of
pneumothorax is approximately 14%. Complications encountered after decompressive procedures for TOS
include long thoracic nerve injury, pneumothorax,
intercostobrachial neuropathy, and arterial and venous
hemorrhages.[5,6,9] In our study, the complication rate
was 18.7%, and the most common complication
was pneumothorax. In cases where the pleura was
opened, tube thoracostomy was performed, and in
fewer patients, tube thoracostomy and hemovac drains
were used. Following the end of the operation, it is
recommended to apply a hemovac drain to the operation
area.[6,9,12] In many studies, tube thoracostomy on
the same side is recommended in case of pleural
tear. There are also studies that recommend opening
the pleura to prevent the development of fibrous
tissue and hematoma formation in the operation
area. Tube thoracostomy and opening the pleura to
prevent hematoma at the operation site have also been
recommended as drainage options.[7,12] According to
our results, hemovac drain or tube thoracostomy did
not affect hospital discharge. From this point of view,
tube thoracostomy as a drainage method becomes a
drainage method that can be preferred alone.
Conditions that negatively affect the quality of
life of patients and complaints that are at a level that
requires reoperation are considered as recurrence.
Neurological findings are more evident in clinical
practice. In published series, it has been reported
that with appropriate patient selection and operation
technique, 80 to 90% success rates are achieved
with surgical treatment, and pain complaints are
significantly reduced.[5-8] This rate is 97% in the case
series of Urschel et al.[11] In our follow-up results, we
saw that there was recurrence in three cases. While
neurological findings were observed in two of these
cases, vascular findings were prominent in one case.
Two of our patients were directed to receive physical
therapy, and one patient was operated on due to
vascular findings and the symptoms affecting the
quality of life. In our study, the success rate of our
surgical interventions was 90.6%.
The retrospective nature and the relatively small
number of patients included are among the limitations
of our study. Nonetheless, although the small sample
size may limit our ability to analyze and compare our
data to other previously published studies, statistical
power in the present study still correlates with the
overall conclusions.
In conclusion, it was determined that the
complaints of TOS patients coincided with the period when physical activity was most intense, and
housewifery has an important place in the etiology
of TOS in Türkiye. Significant improvements were
observed between the tests evaluated for TOS
preoperatively and those performed postoperatively.
High surgical success rate was observed in our
patients who failed in conservative treatment, and
transaxillary approach appears to be an effective
method of treatment.
Acknowledgements: The author wishes to thank Doç.
Dr. Mehmet Yıldırım, who supported in the study as thesis
advisor.
Ethics Committee Approval: This thesis study was
performed at Dr Siyami Ersek Education and Research
Hospital, Thoracic Surgery Clinic, with the permission
of the thesis jury. Approved on 23.12.2010. The study
was conducted in accordance with the principles of the
Declaration of Helsinki.
Patient Consent for Publication: A written informed
consent was obtained from each patient.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Conflict of Interest: The author declared no conflicts of
interest with respect to the authorship and/or publication of
this article.
Funding: The author received no financial support for the
research and/or authorship of this article.
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