@article{ref1,
title="Thoracic outlet syndrome after motor vehicle accidents in a Canadian pain clinic population",
journal="Clinical journal of pain",
year="1995",
author="Mailis, A. and Papagapiou, M. and Vanderlinden, R. G. and Campbell, V. and Taylor, Alan",
volume="11",
number="4",
pages="316-324",
abstract="OBJECTIVE: To record symptoms and signs, operative findings, and long-term outcome in operated and nonoperated patients with the diagnosis of thoracic outlet syndrome after a motor vehicle accident. DESIGN: Descriptive prospective study. SETTING: Pain clinic population in the Toronto Hospital (Western Division), Toronto, Ontario, Canada. PATIENTS: Thirty-two patients diagnosed as having thoracic outlet syndrome after injuries sustained in a car accident (based on specific symptoms and signs as well as exclusion of other disorders generating brachialgia). INTERVENTIONS: Conservative management versus transaxillary or supraclavicular exploration of the thoracic outlet. OUTCOME MEASURES: Pain/symptom relief. RESULTS: Most patients presented with pain and paresthesiae, but conspicuous discoloration of the symptomatic extremity was seen in 41%. Osseous anomalies were seen in 22% of the patients in simple neck x-rays. Vascular studies were abnormal in 24% of tested patients. During transaxillary first rib resection in 15 patients, 87% were found to have musculotendinous and less often osseous anomalies compromising primarily the lower trunk of the brachial plexus. Long-term follow up demonstrated very good pain relief (based on patients' estimates) only in 47% of the operated patients and 20% of the conservatively treated patients. Reoperation was necessary in six cases through a supraclavicular decompression with only one patient experiencing substantial improvement with long-term follow-up. The difficulties in diagnosis as well as reasons for failures of conservative and surgical management are discussed, and the authors' current protocol for diagnosis and management is presented.<p /><p>Language: en</p>",
language="en",
issn="0749-8047",
doi="",
url="http://dx.doi.org/"
}