METHODS:
MR Neurography with three dimensional reconstructions was used as the primary diagnostic test in patients with history and physical exam findings consistent with thoracic outlet syndrome. Image guided scalene injection was used as a confirmatory test in equivocal cases. Surgery was directed at the lesion identified in the imaging test and adhesiolytic agents (Seprafilm or Adcon-L) were used intraoperatively. Patients were then followed for outcome over periods ranging from 6 months to five years.

RESULTS:
One hundred and thirty five patients were referred for imaging and of these, 71 were selected for surgery. The surgical approach was either supraclavicular (62 operations) or transaxillary (41 operations) for neurolysis and none of the patients had first rib resection. Sixteen of the 71 patients had both supraclavicular and transaxillary surgery and six had bilateral surgery. Eight of the surgeries were reoperations after recurrence commencing as early as three months and as late as 9 months after initial surgery (recurrence rate of 9%). Of the eight reoperative patients only three failed to retain lasting benefits from the reoperation. Good or excellent outcomes were obtained in 77%, slight improvement in 9% and no improvement in 14%. Complications included two patients with allergy to the adhesiolytic agent, one pneumothorax, and two wound infections.

CONCLUSIONS:
These results demonstrate that MR Neurography reliably predicts which patients will benefit from thoracic outlet surgery and that recurrence rates are low when adhesiolytic agents are used.