Effects of a 3-week Inpatient Rehabilitation for Neurogenic Thoracic Outlet Syndrome on Strength, Pain, and Function: A Prospective Study

Background

Neurogenic thoracic outlet syndrome (NTOS) is due to the compression of the brachial plexus and is responsible for upper limb pain, strength loss and fatigability, which are responsible for daily life impairment. We assessed prospectively the effect of a 3-week inpatient rehabilitation on upper limb strength and endurance, and to assess pain and function in patients with NTOS.

Methods

Among patients with NTOS, 220 addressed to rehabilitation were included. Patients performed a shoulder isokinetic testing of the rotator cuff and an isometric hand strength measurement, at the beginning and the end of the rehabilitation, and at 24 weeks. Patients completed a QuickDASH questionnaire, and pain was evaluated with a numeric rating scale (NRS). Sick leave rate was also assessed.

Results

Out of 220 patients, 182 performed the 3 evaluations: 78% were female, mean age was 40.7 ± 9.7 years. Initially, symptomatic upper limbs had significantly less strength than asymptomatic upper limbs. At 24 weeks, the rotators strength had increased from 13 to 18% on symptomatic shoulders, and from 4 to 12.5% on asymptomatic shoulders; the rotators endurance increased from 35% to 39% on symptomatic shoulders and from 20% to 22% on asymptomatic shoulders (P ≤ 0.001). The grip and key-pinch measures increased by 22% and 13%, on symptomatic hands, respectively, and by 12% and 8%, on asymptomatic hands, respectively (P ≤ 0.001). The QuickDASH decreased from 57 ± 14% to 30 ± 19% (P ≤ 0.001) and the NRS from 5.6 ± 1.8 to 2.4 ± 2.0 (P ≤ 0.001). The sick leave rate decreased from 66 to 43% (P ≤ 0.0001).

Conclusion

Three weeks of inpatient rehabilitation for NTOS permitted to recover significant bilateral upper limb strength and endurance, both on hands and shoulders, with a maintenance of the results at 24 weeks. These results were associated to a significant reduction of pain and impairment.