Objectives. To compare the outcome of early surgical intervention versus late surgical treatment in cases of neurogenic thoracic outlet syndrome (NTOS). Design. Prospective study. Settings. Secondary care (Al-Minia University Hospital, Egypt) from 2007 to 2010. Participants. Thirty-five patients of NTOS (25 women and 10 men, aged 20–52 years), were classified into 2 groups. First group (20 patients) was operated within 3 months of the onset and the second group (15 patients) was operated 6 months after physiotherapy. Interventions. All patients were operated via supraclavicular surgical approach. Outcomes Measures. Both groups were evaluated clinically and, neurophysiologically and answered the disabilities of the arm, shoulder, and hand (DASH) questionnaire preoperatively and 6 months after the surgery. Results. Paraesthesia, pain, and sensory nerve action potential (SNAP) of ulnar nerve were significantly improved in group one. Muscle weakness and denervation in electromyography EMG were less frequent in group one. The postoperative DASH score improved in both groups but it was less significant in group two ( in group 1 and in group 2). Conclusions. Surgical treatment of NTOS improves functional disability and stop degeneration of the nerves. Early surgical treatment decreases the occurrence of muscle wasting and denervation of nerves compared to late surgery. 1. Introduction Thoracic outlet syndrome (TOS) is defined as a group of clinical symptoms caused by the entrapment of neurovascular structures (subclavian vessels and the brachial plexus) en route to the upper limb via the superior thoracic outlet [1]. This is generally due to a congenital bony anomaly either because of the presence of a cervical rib, a prolongation of the C7 transverse process, or being secondary to fibrous bands or anomalous muscles [2]. Also, trauma such as hyperextension-flexion injuries of arm, neck trauma due to motor vehicle accidents, repetitive stress injury, and trauma that causes chronic cervical muscle spasm may precipitate NTOS [3, 4]. Most of the patients 95% have a neurogenic form, 2% have venous symptoms and only 1% has clinical arterial compression [5]. The diagnosis of neurogenic TOS is relatively straightforward. It is presented with pain and sensory disturbance predominantly in the ulnar forearm and hand, aggravated by use of the affected limb. Weakness and wasting of the small hand muscles are also reported. Neurophysiological studies confirming chronic postganglionic axonal loss, and excluding focal mono-neuropathy [6]. Surgical management is controversial
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