Traffic accident induced thoracic outlet syndrome: decompression without rib resection, correction of associated recurrent thoracic aneurysm.

Traffic accident injuries accounted for the sum of 72 billion in the United States last year. These injuries included Thoracic Outlet Syndrome and its associated Thoracic Aortic Aneurysms. Typically, the injured person has stopped for a red traffic light when another vehicle of higher speed and weight hits the stopped vehicle from behind. The force exerted hyperextends the neck and stretches the scalenus muscles. The muscles stretch, bleed, hypertrophy, and shorten. This process further narrows the already crowded triangular tunnel through which the neurovascular bundle passes. Sixty-five severely symptomatic Thoracic Outlet patients were operated on no sooner than two months after the accident to allow the non-surgical measures to take effect. The median age for these patients was 33.8 years. The female to male preponderance was 40/25. All patients had MRI of the cervical spine to rule out radiculopathy. MRI of the thorax was also requested when a Thoracic Aneurysm was suspected. Nerve conduction tests of the upper extremities were also taken to support the diagnosis. The most valuable clinical test was Elevated Arm Stress Exercising which was positive in all cases. At operation, the Brachial Plexus was compressed mostly by the hypertrophied, adherent, and fibrous scalenus medius from behind. The approach was anterior and supraclavicular in all cases including the recurrent one. Both scalenus medius and anticus were largely resected to enlarge the Thoracic Outlet triangular tunnel. The first rib was not resected in any of these patients, but all costo-cervical ligaments and bands and/or cervical ribs were resected.(ABSTRACT TRUNCATED AT 250 WORDS)