Complications
Pain typically appears in the shoulder and upper arm on the lateral aspect. Clinical history usually substantiates this if the symptoms occur within the first 3 months. Tests show increased sympathetic activity and suggest a rebound phenomenon from the non-sympathectomised adjacent dermatomes. Rebound may be a regeneration of nerve fibres or increased response of peripheral nerves to catecholamines. Symptoms may resolve in 3-6 weeks with conservative management.[209]
Delay in the diagnosis of venous thoracic outlet syndrome (TOS) can also result in embolisation (incidence of pulmonary embolism can range between 10% to 20% of cases).[14] Diagnosis can be made clinically (e.g., shortness of breath, pleuritic chest pain), with abnormal vital signs (e.g., tachycardia, tachypnoea, hypoxaemia), possibly an abnormal ECG (e.g., SI QIII TIII pattern), and confirmatory imaging for pulmonary embolism (e.g., V/Q scan or CT angiography of the chest).
Delay in the diagnosis of arterial TOS can result in aneurysm formation, thrombosis, embolisation, ischaemia, and retrograde embolic CVA/stroke.[19][20][88][210] Diagnosis is clinical (e.g., signs of local ischaemia on physical examination or signs of CVA/stroke). Management is through emergent revascularisation of the extremity.
Delay in the diagnosis of true neurogenic thoracic outlet syndrome in patients with hand muscle atrophy and electrodiagnostic abnormalities (Gilliatt-Sumner hand) can result in progressive and permanent nerve damage. Management is through surgical exploration of the thoracic outlet.
Complications include injury to the neural structures (i.e., brachial plexus, intercostobrachial nerve, phrenic nerve), bleeding, infection, pneumothorax, pleural effusion, chylothorax, and post-operative arterial thrombosis.
In contemporary thoracic outlet surgery practice, the risks of brachial plexus or phrenic nerve injury, or major vascular complications, are quite low, generally 1% or less.[183][184][185][186]
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