(RxWiki News) When treatment for a nerve compression disorder does not relieve pain, both patients and doctors may consider surgery as the next step. Surgery can seem like an extreme option, but for some patients, it may be the right choice.
Two recent studies looked at the surgical treatment of compressed nerves in the neck and shoulder.
The first study reported adolescents had more significant improvements in use of the shoulder, arm and hand, as well as less pain and less severe symptoms following surgery compared to adults.
The second study reported that minimally invasive surgery in certain cases may be just as beneficial as traditional surgery.
"In pain? Call a doctor."
Robert W. Thompson, MD, of the Washington University Center for Thoracic Outlet Syndrome at Barnes-Jewish Hospital authored both studies. The first study looked at the effect of age on surgery results and the second study compared the results of traditional surgery to less invasive surgery.
Neurogenic thoracic outlet syndrome (NTOS) is a condition known to affect baseball pitchers and other athletes. The condition is caused by compression of nerves in the neck and shoulder and usually results in pain in the neck and upper back and numbness or tingling in the fingers.
The condition is normally treated with physical therapy, anti-inflammatory medication and muscle relaxants.
Daniel Clearfield, DO, a sports medicine physician and dailyRx Contributing Expert commonly sees and treats NTOS. He finds that patients respond well to osteopathic manipulative treatment, notably a deep form of massage therapy known as myofascial release to the shoulder muscles, neck muscles and other areas that may be compressed.
Osteopathic manipulative treatment is a hands-on treatment that improves joint range of motion and balances tissue.
“Between performing osteopathic manipulative treatment and getting the patients into physical therapy, I have had very few that have required surgery,” added Dr. Clearfield, who suggests trying all non-operative options before considering surgical procedure.
For those opting for surgery, structures causing compression like the first rib are often removed to relieve pressure on the nerves.
The first study compared the results of traditional surgery in 35 adolescent patients to 154 adult patients.
The adolescent patients were less than 21 years old and had an average age of 17. The adult patients were over 21 years of age and had an average age of 40.
The patients were assessed before surgery, three months after surgery and six months after surgery. The researchers assessed the patients with a survey covering disabilities of the arm, shoulder and hand, a symptom questionnaire and a 10-point pain scale.
Both the adolescents and adults showed improvement at three and six months, but the adolescent group showed more improvement. The adolescents scored four times better when all assessments results were combined.
Pain medication use among the adults was four times higher than among the adolescents.
The second study compared the use of traditional surgery in 143 patients to outpatient surgery in 57 patients.
The traditional surgery group experienced pain and tenderness in the side of the neck above the collarbone and the upper chest just below the collarbone, near the shoulder. The outpatient group had pain only under the collarbone.
The traditional surgery involved the removal of the first rib and some muscles in the neck. In addition, the tendon of the pectoralis minor muscle, which connects to the top and front of the shoulder blade, was detached.
Those in the outpatient group received detachment of the pectoralis minor tendon only.
Patient status was assessed before surgery and three months after surgery. The same survey covering disabilities of the arm, shoulder and hand used in the first study was also used in the second study.
The results in both groups in the second study were similar. About 75 percent of patients showed improved function.
The researchers noted that this study is important for determining who is a good candidate for surgery to treat NTOS.
The studies were published in the Journal of Vascular Surgery.
Financial support was provided by the Thoracic Outlet Syndrome Research and Education Fund of the Barnes-Jewish Hospital Foundation.
