Ann Thorac Surg 1997;63:939
© 1997 The Society of Thoracic Surgeons
Discussion
Discussion
See also page 935.
DR LAURENS R. PICKARD (Houston, TX):
Doctor Urschel, you have informed us in the past about some of the medical-legal problems associated with this condition, but a question has come up in my mind about some people who have written about the etiology of the condition associated with trauma, sometimes even minor trauma, like whiplash injuries, and so I was really interested in what you thought about that.
DR URSCHEL:
Of the fair and poor group of patients, about 85% of them had traumatic experiences. The worst trauma seems to be the "whiplash," resulting from being hit from behind and causing a "cervical syndrome" as well as thoracic outlet syn-drome. This group does not do as well as the group in which the condition came on spontaneously without trauma.
Clavicular traumas, eg, secondary to motorcycle accidents, with callus of the clavicle, do extremely well with first rib resection and neurolysis. (The clavicle is not usually removed.) We have had only 40 cases where we have taken the clavicle out, some of them on both sides, but generally you do not have to do that.
Workmen's compensation with malingering has been associated with "poor" results. Without conduction studies on these pain problems, I think it is difficult clinically. If somebody has a marked improvement in the conduction velocity and is complaining, it is much easier to treat that patient conservatively. On the other hand, if the conduction velocities are depressed, reoperation may well be necessary.
Related Article
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Upper Plexus Thoracic Outlet Syndrome: Optimal Therapy
- Harold C. Urschel, Jr and Maruf A. Razzuk
Ann. Thorac. Surg. 1997 63: 935-939.
[Abstract]
[Full Text]
