Utility of the scratch collapse test for diagnosis of neurogenic thoracic outlet syndrome: Patient-reported outcomes after surgical treatment with at least 1 year follow-up

Abstract

Introduction

This study introduces the Scratch Collapse Test as a diagnostic tool for Neurogenic Thoracic Outlet Syndrome (NTOS) and analyzes and evaluates functional and patient-reported outcomes with at least one year of post-surgical follow-up.

Methods

Forty-four consecutive patients who underwent surgery for NTOS were reviewed. Patients were contacted at least one year postoperatively and assessed using standardized patient-reported outcome measures (PROMs), including Visual Analog Scale (VAS) for pain, Derkash classification, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Michigan Hand Outcomes Questionnaire (MHQ), and Cervical Brachial Symptom Questionnaire (CBSQ). Data were analyzed using t-tests and linear regression models.

Results

The NTOS site of involvement was supraclavicular (SC) in 12 (27.3%) patients, infraclavicular (IC) in 16 (36.4%), and both (SC and IC) in 16 (36.4%). A distal compression site was treated in 20 (45.5%) patients. The overall success rate, as assessed through the Derkash classification, was 87.5%. The mean postoperative VAS score (2.6 + 3.2) was significantly improved from the preoperative VAS score (8.0 + 2.9). Mean postoperative DASH, MHQ, and CBSQ scores were 32.8 ± 21.8, 68.1 ± 26.5, and 39.2 ± 32.6, respectively. Multiple linear regression analysis showed that a longer duration of symptoms before surgery was the most significant factor for a higher mean postoperative VAS pain score.

Conclusion

Longer time to surgery was associated with higher postoperative VAS pain scores, suggesting that earlier surgical intervention in NTOS patients may be beneficial. Higher VAS scores were significantly correlated with poorer postoperative mid-term outcomes as assessed through the DASH, MHQ, CBSQ scores, and Derkash classification.