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Early effectiveness of isolated pectoralis minor tenotomy in selected patients with neurogenic thoracic outlet syndrome.
[thoracic outlet syndrome]
This
study
evaluated
the
early
effectiveness
of
isolated
pectoralis
minor
tenotomy
(
PMT
)
in
the
surgical
treatment
of
selected
patients
with
neurogenic
thoracic
outlet
syndrome
(
NTOS
)
compared
with
supraclavicular
decompression
(
SCD
;
as
scalenectomy
,
neurolysis
,
and
first
rib
resection
)
plus
PMT
(
SCD
+
PMT
)
.
Data
were
obtained
for
200
patients
undergoing
operative
treatment
for
disabling
NTOS
between
2008
and
2011
.
Isolated
PMT
was
offered
to
57
patients
with
physical
examination
findings
limited
to
the
subcoracoid
space
,
and
SCD
+
PMT
was
offered
to
143
with
scalene
triangle
and
subcoracoid
findings
.
Functional
outcomes
were
assessed
before
and
3
months
after
surgery
using
the
Disabilities
of
the
Arm
,
Shoulder
and
Hand
(
DASH
)
survey
and
related
instruments
.
There
were
no
significant
differences
(
P
>
.
05
)
between
PMT
and
SCD
+
PMT
patients
with
respect
to
age
(
overall
,
37
±
1
years
)
,
sex
(
73
%
women
)
,
side
affected
(
52
%
right
,
14
%
bilateral
)
,
or
the
frequency
of
various
NTOS
symptoms
,
but
fewer
PMT
patients
had
a
bony
anomaly
(
0
%
vs
18
%
;
P
<
.
01
)
or
a
history
of
injury
(
35
%
vs
61
%
;
P
<
.
01
)
.
Mean
preoperative
DASH
scores
were
similar
between
PMT
and
SCD
+
PMT
groups
(
49
.
9
±
3
.
6
vs
50
.
8
±
1
.
6
)
,
but
previous
use
of
opiate
pain
medications
was
higher
in
PMT
patients
(
47
%
vs
20
%
;
P
=
.
0004
)
.
PMT
was
conducted
as
an
outpatient
procedure
,
whereas
the
mean
hospital
stay
after
SCD
+
PMT
was
4
.
8
±
0
.
1
days
,
with
two
patients
(
1
%
)
requiring
early
reoperations
for
persistent
lymph
leaks
.
Mean
DASH
scores
3
months
after
surgery
were
significantly
improved
after
isolated
PMT
(
29
.
6
±
4
.
2
;
P
<
.
01
)
and
SCD
+
PMT
(
41
.
5
±
2
.
2
;
P
<
.
01
)
,
but
the
mean
extent
of
improvement
in
DASH
scores
was
not
significantly
different
in
PMT
(
32
%
±
9
%
)
vs
SCD
+
PMT
(
19
%
±
5
%
)
.
There
were
also
no
significant
differences
in
the
proportion
of
PMT
vs
SCD
+
PMT
patients
demonstrating
improvement
in
functional
outcome
measures
(
75
%
vs
72
%
)
or
in
overall
use
of
opiate
medications
(
35
%
vs
27
%
)
.
Isolated
PMT
is
a
low
-risk
outpatient
procedure
that
is
effective
for
the
treatment
of
selected
patients
with
disabling
NTOS
,
with
early
outcomes
similar
to
SCD
+
PMT
.
These
findings
emphasize
the
importance
of
recognizing
subcoracoid
brachial
plexus
compression
as
part
of
the
spectrum
of
NTOS
and
support
the
role
of
PMT
in
surgical
management
.
Diseases
Validation
Diseases presenting
"early effectiveness"
symptom
thoracic outlet syndrome
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