Finally clarity for a large group of patients with vague pain complaints in the neck, shoulder and hand

The Catharina Hospital is the first hospital in the Netherlands to develop a successful care path for patients with neurogenic thoracic outlet syndrome (NTOS). Patients with NTOS have various complaints of the neck, shoulder, arm and / or hand that are caused by compression of the nerve bundle in the shoulder region.

Due to the complexity of the diagnosis, unclear naming and qualitative poor scientific research, this clinical picture is not recognized or recognized by many doctors. A few years ago, a care path was drawn up in the Catharina Hospital where it can be determined in an effective and efficient way whether a patient has NTOS or not.

From counter to counter

“Patients with NTOS who come to us have often been sent from counter to counter for years in severe pain. Due to the unfamiliarity and complexity of the clinical picture, the correct diagnosis was often not made. This is often very frustrating for patients! ”, Says Niels Pesser, researcher at the TOS center. “A few years ago we developed a new care path with a team of vascular surgeons, neurologists, physiotherapists, radiologists, pain anesthetists and orthopedists, and it turns out: with success!”, Says neurologist Dr. Bart van Nuenen of the Catharina Hospital. Research among 856 patients diagnosed with NTOS shows that our approach helps to find an appropriate treatment.

In 39% of the patients with NTOS, specialized physiotherapy appeared to be a good treatment and surgery was not necessary. An operation, a so-called thoracic outlet decompression, was performed in the remaining 61% of the patients.

Quality of life

A total of 274 patients were followed who performed this surgery to measure arm function and quality of life. These results were compared with the situation before surgery. Significant improvement in arm function and quality of life was seen after surgery. In total, 72% of the patients had no or minimal residual complaints. The results are published in the medical scientific journal EJVES, the highest-rated journal for vascular surgery.

Praising about results

These results are a first step towards a fully scientifically proven care path for NTOS patients. This study is expected to contribute to the recognition and recognition of NTOS as a clinical picture. In addition, the comparison of results from other hospitals is made easier by applying the care path from Catharina Hospital. In a response to the article, it appears that doctors from other – foreign – hospitals are full of praise for the results and possibilities. It is stated that the article is a ‘benchmark’ for future scientific research and shows a way to achieve proper diagnosis and treatment of the often unrecognized or recognized group of NTOS patients.^*

After analysis by a neurologist in their own region, patients with complaints that may indicate NTOS can be referred to the specialized TOS team at Catharina Hospital.

^* Reference: A Multidisciplinary Approach to Neurogenic Thoracic Outlet Syndrome: Sinking Deeper or Stepping Out of a Chaotic Quagmire Onto Terra Firma?

Photo: Patient with NTOS undergoes surgery

Source: Catharina Hospital

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