jkssh Journal of the Korean Society for Surgery of the Hand J Korean Soc Surg Hand 1598-3889 2234-0998 The Korean Society for Surgery of the Hand 10.12790/jkssh.2016.21.3.113 jkssh-21-113 ORIGINAL ARTICLE Prevalence and Clinical Characteristics of Neurogenic Thoracic Outlet Syndrome in Specific Industrial Field KimSang-Hyo BaekSamuel KwonYoung-Ho Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea Correspondence to: Young-Ho Kwon, Department of Orthopaedic Surgery, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea, TEL: +82-51-990-6467, FAX: +82-51-243-0181, E-mail: handkwon@hotmail.com 09 2016 11 09 2016 21 3 113 121 20052016 11082016 14082016 Copyright © 2016 The Korean Society for Surgery of the Hand 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose:

The aim of this study was to analyze the multiple factors as a cause of thoracic outlet syndrome (TOS) in specific industrial field which is a South Korea company manufacturing rolling stock, defense products and plant equipment.

 Methods:

We analyzed questionnaire survey of 30 patients diagnosed as TOS at outpatient department from January 2005 to October 2015 retrospectively. We reviewed clinical records and questionnaire about repetitive task related to microtrauma. Questionnaire was established to analyze the correlation between occupational history and TOS. Statistical test was done with multiple regression analysis.

 Results:

Incidence rate was 9%, all of 30 patients engaged in heavy workload with symptoms of pain in neck and shoulder. A multiple regression was run to predict arm visual analogue scale (VAS) score from age, force of work, time of work and career. The model of analysis for arm VAS was statistically significant, p<0.001, adjusted r2=0.489. Only force of work variable added was statistically significantly to the prediction, p<0.001.

 Conclusion:

Prevalence of TOS in highly loaded industrial field is higher than typically known, appropriate diagnosis is important for early comeback to work. Aggressive diagnosis and treatment is important since non-operative treatment can have satisfying result for patient and help early comeback to work.

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Characteristics of patients

No. Age (yr) Sex Type of work Career (mo) Time of work (hr) Force of work (Borg scale) Neck VAS Arm VAS Period (mo) Recur period (mo)
1 59 Male Welder 432 2-4 7 4 8 424 6
2 53 Male Supervisor 336 2-4 5 4 6 330 3
3 50 Male Assembler 348 2-4 6 4 6 346 1
4 60 Male Assembler 336 >4 9 8 8 192 24
5 57 Male Assembler 384 2-4 6 4 6 264 3
6 56 Male Welder 324 2-4 6 6 6 228 1
7 54 Male Assembler 360 2-4 6 4 6 252 3
8 53 Male Inspector 360 1-2 4 6 4 300 2
9 53 Male Inspector 336 1-2 3 6 4 240 2
10 59 Male Pipe attacher 444 >4 4 6 6 120 1
11 53 Male Assembler 432 2-4 5 6 6 372 5
12 57 Male Assembler 416 2-4 5 6 6 180 0.5
13 52 Male Mechanic 356 2-4 5 6 6 240 1
14 54 Male Mechanic 344 2-4 5 4 6 240 0.5
15 56 Male Assembler 344 1-2 5 6 6 120 6
16 50 Male Supervisor 404 1-2 5 6 6 300 7
17 54 Male Assembler 368 2-4 6 6 6 228 3
18 39 Male Painter 332 2-4 4 6 6 180 1-2
19 53 Male Assembler 296 2-4 6 6 8 108 6
20 60 Male Welder 380 2-4 6 6 4 240 12
21 54 Male Assembler 308 2-4 5 6 6 240 1
22 58 Male Welder 356 2-4 6 6 8 300 3
23 42 Male Mechanic 236 1-2 5 6 8 120 12
24 45 Male Welder 245 >4 7 8 8 210 3
25 52 Male Painter 347 2-4 8 7 9 300 4
26 57 Male Assembler 368 >4 7 7 6 300 6
27 47 Male Assembler 250 2-4 7 5 7 200 6
28 49 Male Welder 264 >4 6 6 8 240 6
29 53 Male Painter 310 >4 8 6 8 280 3
30 51 Male Assembler 305 2-4 7 5 9 290 2

VAS, visual analogue scale.

Cases of work related stress and posture

Type of work posture No.a)
Occupation which repeats same action using the neck 20
Occupation which repeats same action (more than 2.5 times per a minute) using the shoulders 19
Occupation which the hands are located above the head 20
Occupation which the elbows are located above the shoulder 20
Occupation which lifts the elbows from the trunk 20
Occupation which locates the elbows behind the trunk 17
Occupation which carries an item weight more than 4.5 kg with one hand or grasps with the same power without support 16
Occupation which lifts an item weight more than 4.5 kg, more than 2 times per a minute 15
Occupation which intensively manipulates keyboard or mouse 2
Occupation with arms outstretched 14
Occupation using vibrating power tools (an impact, torque, or grinder etc.) 17
Occupation which fixes the shoulders (static posture) 21

Most object research group worked with vibrating tools and repetitively engaged in occupation which burdens to neck and shoulders.

No., duplication is possible according to work posture.

Multiple regression analysis among career, force of work and time of work and arm VAS

Dependent variable Independent variable β SE p-value VIF
Arm VAS (Constant) - 2.380 - -
Force of work 0.597 0.168 0.001 1.526
Time of work 0.114 0.394 0.506 1.629
Age -0.264 0.061 0.186 2.139
Career -0.080 0.005 0.679 2.077

A multiple regression was run to predict arm VAS score from age, force of work, time of work and career. These variables statistically significantly predicted arm VAS (p<0.001, adjusted R2=0.489).

VAS, visual analogue scale; β, estimated regression coefficient; SE, standard error; VIF, variance inflation factor.

Multiple regression analysis among career, force of work and time of work and neck VAS

Dependent variable Independent variable β SE p-value VIF
Neck VAS (Constant) - 2.670 - -
Force of work 0.037 0.189 0.875 1.526
Time of work 0.256 0.442 0.293 1.629
Age 0.053 0.068 0.847 2.139
Career -0.211 0.005 0.442 2.077

A multiple regression was run to predict neck VAS score from age, force of work, time of work and career. The results were not statistically significant (p<0.476, adjusted R2=-0.013).

VAS, visual analogue scale; β, estimated regression coefficient; SE, standard error; VIF, variance inflation factor.

Type of treatment

Treatment No. (%)
Scalene injection 2 (6.6)
Medication, physical therapy 1 (3.3)
Medication, scalene injection 5 (16.6)
Medication, physical therapy, scalene injection 8 (26.6)
Medication, trigger point injection, scalene injection 3 (10.0)
Medication, physical therapy, trigger point injection, scalene injection 11 (36.6)
Total 30 (100.0)

Most object research group was treated with combination therapy of medication, physical therapy, trigger point injection and scalene injection.