Post-traumatic neurogenic thoracic outlet syndrome: Clinical presentation and surgical outcomes–A retrospective cohort study
- 1Branch of Clinical Sciences, College of Medicine, University of Sulaimani, Sulaimani Shar Teaching Hospital, Iraq
- 2College of Medicine, Branch of Clinical sciences, University of Sulaimani, Sulaimani Shar Teaching Hospital, Iraq
Abstract
Objective: Post-traumatic neurogenic thoracic outlet syndrome remains an underreported condition, particularly in high-trauma and resource-limited settings. This study aimed to characterize the clinical presentation of post-traumatic neurogenic thoracic outlet syndrome and evaluate functional outcomes, recurrence, and factors associated with outcomes following surgical decompression.
Methods: This retrospective cohort study included 400 consecutive patients with post-traumatic neurogenic thoracic outlet syndrome who underwent supraclavicular thoracic outlet decompression between 2007 and 2024. Patients with arterial or venous thoracic outlet syndrome were excluded. All patients underwent first-rib resection with anterior and middle scalenectomy and excision of associated anomalous osseous structures when present. Functional outcomes were assessed using the disabilities of the arm, shoulder, and hand score. Recurrence-free survival was evaluated using Kaplan–Meier analysis, and multivariable regression was used to identify factors associated with recurrence and functional improvement. The follow-up duration ranged from 24 to 60 months.
Results: The mean participant age was 36.1 ± 9.5 years, and 255 patients (63.7%) were women. Falls from height (27.3%), physical assault (26.0%), pedestrian injury (24.8%), and road traffic accidents (22.0%) were the principal trauma mechanisms. Cervical ribs were present in 37.0% and elongated transverse processes in 30.8% of the study participants. The mean disabilities of the arm, shoulder, and hand score decreased from 54.8 ± 9.0 preoperatively to 9.8 ± 6.0 postoperatively (p < 0.001). During follow-up, 120 patients (30.0%) developed recurrence. Cervical rib was associated with increased recurrence (odds ratio: 1.50, 95% confidence interval: 1.05–2.10; p = 0.02) and less functional improvement (β = −2.1; p = 0.04). Pneumothorax requiring chest-tube drainage occurred in 2.0%; no major neural or vascular injuries or perioperative deaths were recorded.
Conclusions: In this retrospective cohort, supraclavicular decompression was associated with substantial functional improvement in selected patients with persistent post-traumatic neurogenic thoracic outlet syndrome. Cervical rib may be associated with recurrence and less favorable functional recovery. Prospective multicenter studies are warranted to confirm these findings.
Related
- Neurogenic thoracic outlet syndrome: a review of diagnostic and therapeutic strategies.
- From the Thoracic Outlet to the Brachial Plexus: A Rare Presentation of Pediatric Ewing Sarcoma
- Neurogenic colonic motility patterns and gut transit disrupted in a mouse model of Rett Syndrome
- Morquio A syndrome associated with bilateral hydroureteronephrosis and neurogenic bladder: a rare case report and review of the literature.
- Presentation and management of traumatic breast hematomas: a case series and review of the literature.
BibTeX
@article{rasul2026posttraumatic,
title = {{Post-traumatic neurogenic thoracic outlet syndrome: Clinical presentation and surgical outcomes–A retrospective cohort study}},
author = {Mohammed Yassin Rasul and Bawan Bakr Wahab and Ako Nooralddin Abdalla and Aram BARAM},
journal = {The Journal of International Medical Research},
year = {2026},
month = sep,
doi = {10.1177/03000605261488728},
url = {https://doi.org/10.1177/03000605261488728},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Post-traumatic neurogenic thoracic outlet syndrome: Clinical presentation and surgical outcomes–A retrospective cohort study
AU - Mohammed Yassin Rasul
AU - Bawan Bakr Wahab
AU - Ako Nooralddin Abdalla
AU - Aram BARAM
PY - 2026
DA - 2026/09/22
JO - The Journal of International Medical Research
DO - 10.1177/03000605261488728
UR - https://doi.org/10.1177/03000605261488728
AB - Objective: Post-traumatic neurogenic thoracic outlet syndrome remains an underreported condition, particularly in high-trauma and resource-limited settings. This study aimed to characterize the clinical presentation of post-traumatic neurogenic thoracic outlet syndrome and evaluate functional outcomes, recurrence, and factors associated with outcomes following surgical decompression. Methods: This retrospective cohort study included 400 consecutive patients with post-traumatic neurogenic thoracic outlet syndrome who underwent supraclavicular thoracic outlet decompression between 2007 and 2024. Patients with arterial or venous thoracic outlet syndrome were excluded. All patients underwent first-rib resection with anterior and middle scalenectomy and excision of associated anomalous osseous structures when present. Functional outcomes were assessed using the disabilities of the arm, shoulder, and hand score. Recurrence-free survival was evaluated using Kaplan–Meier analysis, and multivariable regression was used to identify factors associated with recurrence and functional improvement. The follow-up duration ranged from 24 to 60 months. Results: The mean participant age was 36.1 ± 9.5 years, and 255 patients (63.7%) were women. Falls from height (27.3%), physical assault (26.0%), pedestrian injury (24.8%), and road traffic accidents (22.0%) were the principal trauma mechanisms. Cervical ribs were present in 37.0% and elongated transverse processes in 30.8% of the study participants. The mean disabilities of the arm, shoulder, and hand score decreased from 54.8 ± 9.0 preoperatively to 9.8 ± 6.0 postoperatively (p < 0.001). During follow-up, 120 patients (30.0%) developed recurrence. Cervical rib was associated with increased recurrence (odds ratio: 1.50, 95% confidence interval: 1.05–2.10; p = 0.02) and less functional improvement (β = −2.1; p = 0.04). Pneumothorax requiring chest-tube drainage occurred in 2.0%; no major neural or vascular injuries or perioperative deaths were recorded. Conclusions: In this retrospective cohort, supraclavicular decompression was associated with substantial functional improvement in selected patients with persistent post-traumatic neurogenic thoracic outlet syndrome. Cervical rib may be associated with recurrence and less favorable functional recovery. Prospective multicenter studies are warranted to confirm these findings.
SN - 0300-0605
SN - 1473-2300
ER -