Although striving for surgical success, central responsibilities of the surgeon include preventing poor outcomes by identifying factors predictive of failure and promoting improvement among those who initially fail by restructuring postoperative management. The outcome of a scalene block with local anesthetic is useful in predicting surgical candidacy, yet we have shown that patient demographic and clinical variables also play a significant role in differentiating successful from failed surgical outcomes. In our analysis of 182 FRRS performed at our institution, older age was significantly predictive of poor outcome. This association of outcome with age reflects previously find more
reported observations that FRRS was more likely to lead to symptom relief in NTOS patients aged <40 years compared with ��40 years.7 Duration of symptoms has similarly been presented as a predictor of surgical outcome, although both shorter (��24 months) and longer (��24 months) symptom length have been reported as significantly predictive.8?and?9 Our finding of significantly longer symptom duration in unresolved cases supports the latter observation, whereby prolonged compression of the thoracic outlet may cause more extensive and irreversible impairment due to scarring and reconditioning. The association of unresolved symptoms with <a href="http://en.wikipedia.org/wiki/Thalidomide
">Thalidomide comorbid conditions, notably chronic pain syndromes and neck and/or shoulder disease, is not surprising given the tendency of these conditions to resemble NTOS. FRRS will not benefit patients with fibromyalgia, degenerative disk disease, rotator cuff tears, or somatoform disorders instead of true NTOS, even though they may present with weakness, paresthesia, and pain in the upper extremity.10 Previous investigation Wortmannin cell line
has documented unfavorable surgical outcomes among patients with diffuse neurological or motor symptoms and neck and/or shoulder pain.11, 12?and?13 Our analysis supports this association, as the difference in the rate of comorbidities affecting TOS-related regions was highly significant (P < .001) between cases of unresolved and resolved symptoms. This association may be reflective of improper diagnosis or may suggest that comorbid conditions complicate recovery among true cases of NTOS. Beyond patient demographics, preoperative interventions and peri- or postoperative events were also predictive of outcome. FRRS yielding unresolved symptoms was significantly more likely to involve patients with a history of opioid use; these patients were also more likely to have had previous non-TOS surgery in the region of the neck and/or upper extremity, although not at a level of significance (P = .055).