Cervical ribs are a recognised cause of thoracic outlet syndrome (TOS) in children. Symptoms arising from vascular and neurogenic TOS are variable and may overlap giving rise to diagnostic confusion and delayed diagnosis. We aimed to review our experience of management of thoracic outlet syndrome.
Patients with a diagnosis of TOS between March 2005 and January 2016 were identified using ICD-10 Q76.5 and G54.0 codes. Retrospective review of casenotes was carried out with analysis of information including presentation, investigations, operative management, complications and functional outcomes.
Seven patients with a diagnosis of TOS were identified, including 6 females and 1 male. The mean age at presentation was 13.5 years (+/- 1.2 years) and mean duration of symptoms was 6.3 months (+/- 4.6 months). Underlying pathology comprised fibromuscular bands, unilateral cervical rib in 2 cases and bilateral cervical ribs in 4 cases. Five patients presented with neurogenic TOS (71%) and 2 patients presented with arterial TOS (28.6%). Mean duration of follow up was 28.3 months (+/- 22.9 months).
Within the vascular group, one patient required a right axillary bypass which was complicated by arterial embolus requiring embolectomy 1 day post surgery and further interventional angioplasty. Both patients underwent excision of cervical rib with good resolution of symptoms.
Within the neurogenic group, one patient underwent resection of first and second ribs. Two patients underwent unilateral cervical rib removal; one following foramen magnum decompression and another with Klippel Feil syndrome following previous sub-aortic and scoliosis surgery. Two patients underwent asynchronous resection of bilateral cervical ribs. At follow-up, 2 patients are asymptomatic, 1 patient has residual sensory deficit, 2 patients have significant unilateral muscle wasting.
Neurogenic TOF appears to be more frequent than arterial TOF in children with cervical ribs. Neurogenic symptoms are more likely to persist following surgical intervention.