Somatization Tendencies in Surgically Treated Neurogenic Thoracic Outlet Syndrome Patients

Abstract

Vascular thoracic outlet syndromes have well-defined objective diagnostic criteria. Most patients diagnosed with neurogenic thoracic outlet syndrome (NTOS) do not have objective neurologic findings or electrophysiologic abnormalities. The authors have subjectively noted somatization tendencies in many of their NTOS patients. A retrospective case control study was done to identify features of somatoform disorders in their surgically treated NTOS patients. Records of patients admitted for NTOS surgery were retrieved. Patients admitted with spontaneous pneumothorax, another common benign thoracic surgical condition, were used as controls. Thirty patients with NTOS were randomly matched by age and sex to 30 patients with pneumothorax. Patients with NTOS had more previous operations for unrelated conditions (NTOS mean 2.9, pneumothorax mean 1.3, P < 0.005) and took more medications (NTOS, 1.2; pneumothorax, 0.6, P < 0.025) than pneumothorax patients. NTOS patients also had more medication allergies (NTOS, 0.7; pneumothorax, 0.4; P < 0.16), but the difference was not statistically significant. The findings suggest either a greater frequency of organic illness or a greater tendency to undergo medical and surgical treatment in the NTOS group. The authors suspect that some patients with NTOS have coexisting somatoform disorders and that surgical intervention in these patients is inappropriate. Because objective quantification of NTOS severity is usually not possible, patient selection for surgery remains difficult.