Atypical Presentation of Thoracic Outlet Syndrome in Kurdistan of Iraq

Abstract

Background and objective: Thoracic outlet syndrome (TOS) is a clinical phenomenon resulting from compression of neurovascular structures at the superior aperture of the thorax which presents with varying symptoms The aim of this study was to analyze the different kinds of clinical presentation of thoracic outlet syndrome in Kurdistan region of Iraq and its management.

Methods: In Erbil teaching hospital, 150 patients have been studied from February 2000-December 2006. These patients diagnosed as symptomatic thoracic outlet syndrome and have been managed conservatively and surgically.

Results: In this study 97 (64.6%) patients were female, 53 (35.3%) patients were male. Their ages ranged from (17-40) years. There was pain, parasthesia in arm in 69 (46%). Shoulder pain, chest pain and pain in axillarys region with arm pain in 38 (25.3%) patients (diagnosed by cardiologist as they have cardiac problem and treated accordingly without benefit). Incidental findings in 27 (18%) patients with vague symptoms in upper limb, supraclavicular fullness in 2 (1.3%) patients, 12 (8%) patients diagnosed by psychiatrist as having psychological problem (misdiagnosed as obsessive or depressive cases because of there neck pain and headache) and one patient has wasting of hand muscles. Surgery done for 25 (20.5%) patients (supra clavicular approach).

Conclusion: Careful patients history and proper physical and clinical evaluation including nerve conduction study, conventional radiography of cervical spine can decide proper management for symptomatic cases conservatively or surgically.