Diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome is excellent

Kendall Likes, Danielle H. Rochlin, Quinn Salditch, Thadeus Dapash, Yen Baker, Roxanne Deguzman, Shalini Selvarajah, Julie Ann Freischlag

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background The purpose of this study was to categorize patients referred to a specialized thoracic outlet syndrome (TOS) practice to determine the diagnostic accuracy of those who are physician and self-referred. Methods Demographic and clinical data on all patients who were referred for TOS between 2006 and 2010 were retrospectively reviewed from a prospectively maintained institutional review board-approved database and patient records. Results Between 2006 and 2010, 621 patients were referred for TOS (433 women and 188 men; mean age 39 years [range 10-87]). Five hundred seventy-one patients (92%) were diagnosed with TOS, with 421 (74%) neurogenic, 126 (22%) venous, and 24 (4%) arterial TOS cases. Of the 525 physician referrals, 478 (91%) had TOS, and of the 93 self-referrals, 90 (97%) had TOS. The 421 patients with neurogenic TOS (NTOS, 304 women and 117 men) had symptoms on average for 56 months (range 1-516). Two hundred seventy-one patients (64%) were initially treated with TOS-specific physical therapy (PT), and 100 (37%) improved. One hundred seventy-eight patients (42%) underwent a lidocaine block, and 145 patients (81%) had a positive block. Seventy-four patients (18%) underwent Botox injections 44 (60%) of which were positive and the average number of Botox injections was 1.3. One hundred forty patients (33%) underwent transaxillary first rib resection and scalenectomy (FRRS), and 128 patients (91%) improved. Of patients undergoing FRRS, 92 (66%) had a lidocaine block, 82 (89%) of which were positive. Of patients with a positive lidocaine block, 74 (90%) improved after FRRS. Of patients undergoing FRRS, 31 (22%) underwent Botox injections, 15 (48%) of which were positive. Of patients with a positive Botox block, 14 (93%) improved after FRRS. Average length of time between initial visit and operation was 6.4 months (range 2 weeks to 34 months), and average follow-up time was 13 months (range 1 week to 49 months). Conclusions 1) Both referring physicians and patients are very accurate in their preliminary diagnosis of TOS (neurogenic, venous, or arterial TOS). 2) In a specialized TOS practice, two-thirds of patients are sent to TOS-specific PT and one-third improve from this treatment alone. 3) One-third of patients referred for NTOS eventually undergo FRRS with a 91% success rate.

Original languageEnglish (US)
Pages (from-to)1100-1105
Number of pages6
JournalAnnals of Vascular Surgery
Volume28
Issue number5
DOIs
StatePublished - 2014
Externally publishedYes

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Thoracic Outlet Syndrome
Physicians
Ribs
Lidocaine
Injections
Referral and Consultation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Likes, K., Rochlin, D. H., Salditch, Q., Dapash, T., Baker, Y., Deguzman, R., ... Freischlag, J. A. (2014). Diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome is excellent. Annals of Vascular Surgery, 28(5), 1100-1105. https://doi.org/10.1016/j.avsg.2013.12.011

Diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome is excellent. / Likes, Kendall; Rochlin, Danielle H.; Salditch, Quinn; Dapash, Thadeus; Baker, Yen; Deguzman, Roxanne; Selvarajah, Shalini; Freischlag, Julie Ann.

In: Annals of Vascular Surgery, Vol. 28, No. 5, 2014, p. 1100-1105.

Research output: Contribution to journalArticle

Likes, K, Rochlin, DH, Salditch, Q, Dapash, T, Baker, Y, Deguzman, R, Selvarajah, S & Freischlag, JA 2014, 'Diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome is excellent', Annals of Vascular Surgery, vol. 28, no. 5, pp. 1100-1105. https://doi.org/10.1016/j.avsg.2013.12.011
Likes, Kendall ; Rochlin, Danielle H. ; Salditch, Quinn ; Dapash, Thadeus ; Baker, Yen ; Deguzman, Roxanne ; Selvarajah, Shalini ; Freischlag, Julie Ann. / Diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome is excellent. In: Annals of Vascular Surgery. 2014 ; Vol. 28, No. 5. pp. 1100-1105.
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abstract = "Background The purpose of this study was to categorize patients referred to a specialized thoracic outlet syndrome (TOS) practice to determine the diagnostic accuracy of those who are physician and self-referred. Methods Demographic and clinical data on all patients who were referred for TOS between 2006 and 2010 were retrospectively reviewed from a prospectively maintained institutional review board-approved database and patient records. Results Between 2006 and 2010, 621 patients were referred for TOS (433 women and 188 men; mean age 39 years [range 10-87]). Five hundred seventy-one patients (92{\%}) were diagnosed with TOS, with 421 (74{\%}) neurogenic, 126 (22{\%}) venous, and 24 (4{\%}) arterial TOS cases. Of the 525 physician referrals, 478 (91{\%}) had TOS, and of the 93 self-referrals, 90 (97{\%}) had TOS. The 421 patients with neurogenic TOS (NTOS, 304 women and 117 men) had symptoms on average for 56 months (range 1-516). Two hundred seventy-one patients (64{\%}) were initially treated with TOS-specific physical therapy (PT), and 100 (37{\%}) improved. One hundred seventy-eight patients (42{\%}) underwent a lidocaine block, and 145 patients (81{\%}) had a positive block. Seventy-four patients (18{\%}) underwent Botox injections 44 (60{\%}) of which were positive and the average number of Botox injections was 1.3. One hundred forty patients (33{\%}) underwent transaxillary first rib resection and scalenectomy (FRRS), and 128 patients (91{\%}) improved. Of patients undergoing FRRS, 92 (66{\%}) had a lidocaine block, 82 (89{\%}) of which were positive. Of patients with a positive lidocaine block, 74 (90{\%}) improved after FRRS. Of patients undergoing FRRS, 31 (22{\%}) underwent Botox injections, 15 (48{\%}) of which were positive. Of patients with a positive Botox block, 14 (93{\%}) improved after FRRS. Average length of time between initial visit and operation was 6.4 months (range 2 weeks to 34 months), and average follow-up time was 13 months (range 1 week to 49 months). Conclusions 1) Both referring physicians and patients are very accurate in their preliminary diagnosis of TOS (neurogenic, venous, or arterial TOS). 2) In a specialized TOS practice, two-thirds of patients are sent to TOS-specific PT and one-third improve from this treatment alone. 3) One-third of patients referred for NTOS eventually undergo FRRS with a 91{\%} success rate.",
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T1 - Diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome is excellent

AU - Likes, Kendall

AU - Rochlin, Danielle H.

AU - Salditch, Quinn

AU - Dapash, Thadeus

AU - Baker, Yen

AU - Deguzman, Roxanne

AU - Selvarajah, Shalini

AU - Freischlag, Julie Ann

PY - 2014

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N2 - Background The purpose of this study was to categorize patients referred to a specialized thoracic outlet syndrome (TOS) practice to determine the diagnostic accuracy of those who are physician and self-referred. Methods Demographic and clinical data on all patients who were referred for TOS between 2006 and 2010 were retrospectively reviewed from a prospectively maintained institutional review board-approved database and patient records. Results Between 2006 and 2010, 621 patients were referred for TOS (433 women and 188 men; mean age 39 years [range 10-87]). Five hundred seventy-one patients (92%) were diagnosed with TOS, with 421 (74%) neurogenic, 126 (22%) venous, and 24 (4%) arterial TOS cases. Of the 525 physician referrals, 478 (91%) had TOS, and of the 93 self-referrals, 90 (97%) had TOS. The 421 patients with neurogenic TOS (NTOS, 304 women and 117 men) had symptoms on average for 56 months (range 1-516). Two hundred seventy-one patients (64%) were initially treated with TOS-specific physical therapy (PT), and 100 (37%) improved. One hundred seventy-eight patients (42%) underwent a lidocaine block, and 145 patients (81%) had a positive block. Seventy-four patients (18%) underwent Botox injections 44 (60%) of which were positive and the average number of Botox injections was 1.3. One hundred forty patients (33%) underwent transaxillary first rib resection and scalenectomy (FRRS), and 128 patients (91%) improved. Of patients undergoing FRRS, 92 (66%) had a lidocaine block, 82 (89%) of which were positive. Of patients with a positive lidocaine block, 74 (90%) improved after FRRS. Of patients undergoing FRRS, 31 (22%) underwent Botox injections, 15 (48%) of which were positive. Of patients with a positive Botox block, 14 (93%) improved after FRRS. Average length of time between initial visit and operation was 6.4 months (range 2 weeks to 34 months), and average follow-up time was 13 months (range 1 week to 49 months). Conclusions 1) Both referring physicians and patients are very accurate in their preliminary diagnosis of TOS (neurogenic, venous, or arterial TOS). 2) In a specialized TOS practice, two-thirds of patients are sent to TOS-specific PT and one-third improve from this treatment alone. 3) One-third of patients referred for NTOS eventually undergo FRRS with a 91% success rate.

AB - Background The purpose of this study was to categorize patients referred to a specialized thoracic outlet syndrome (TOS) practice to determine the diagnostic accuracy of those who are physician and self-referred. Methods Demographic and clinical data on all patients who were referred for TOS between 2006 and 2010 were retrospectively reviewed from a prospectively maintained institutional review board-approved database and patient records. Results Between 2006 and 2010, 621 patients were referred for TOS (433 women and 188 men; mean age 39 years [range 10-87]). Five hundred seventy-one patients (92%) were diagnosed with TOS, with 421 (74%) neurogenic, 126 (22%) venous, and 24 (4%) arterial TOS cases. Of the 525 physician referrals, 478 (91%) had TOS, and of the 93 self-referrals, 90 (97%) had TOS. The 421 patients with neurogenic TOS (NTOS, 304 women and 117 men) had symptoms on average for 56 months (range 1-516). Two hundred seventy-one patients (64%) were initially treated with TOS-specific physical therapy (PT), and 100 (37%) improved. One hundred seventy-eight patients (42%) underwent a lidocaine block, and 145 patients (81%) had a positive block. Seventy-four patients (18%) underwent Botox injections 44 (60%) of which were positive and the average number of Botox injections was 1.3. One hundred forty patients (33%) underwent transaxillary first rib resection and scalenectomy (FRRS), and 128 patients (91%) improved. Of patients undergoing FRRS, 92 (66%) had a lidocaine block, 82 (89%) of which were positive. Of patients with a positive lidocaine block, 74 (90%) improved after FRRS. Of patients undergoing FRRS, 31 (22%) underwent Botox injections, 15 (48%) of which were positive. Of patients with a positive Botox block, 14 (93%) improved after FRRS. Average length of time between initial visit and operation was 6.4 months (range 2 weeks to 34 months), and average follow-up time was 13 months (range 1 week to 49 months). Conclusions 1) Both referring physicians and patients are very accurate in their preliminary diagnosis of TOS (neurogenic, venous, or arterial TOS). 2) In a specialized TOS practice, two-thirds of patients are sent to TOS-specific PT and one-third improve from this treatment alone. 3) One-third of patients referred for NTOS eventually undergo FRRS with a 91% success rate.

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