Journal List > J Korean Soc Surg Hand > v.21(3) > 1106523

TOOLS
Kim, Baek, and Kwon: Prevalence and Clinical Characteristics of Neurogenic Thoracic Outlet Syndrome in Specific Industrial Field
ORIGINAL ARTICLE

J Korean Soc Surg Hand 2016;21(3):113-121.

Published online: 11 September 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.3.113

Prevalence and Clinical Characteristics of Neurogenic Thoracic Outlet Syndrome in Specific Industrial Field

Sang-Hyo Kim, Samuel Baek, Young-Ho Kwon

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

Received 20 May 201611 August 2016       Accepted 14 August 2016

Copyright © 2016 The Korean Society for Surgery of the Hand

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.

Abstract

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.

Keywords: Thoracic outlet syndrome, Prevalence, Occupational diseases

REFERENCES

1. Urschel HC Jr, Razzuk MA. Neurovascular compression in the thoracic outlet: changing management over 50 years. Ann Surg. 1998; 228:609–17.
2. Wojcik G, Sokolowska B, Piskorz J. Epidemiology and pathogenesis of thoracic outlet syndrome. Curr Issues Pharm Med Sci. 2015; 28:24–6.
crossref
3. Yudoyono F, Senjaya F, Yuniarti M, Gunawan V, Arifin MZ, Faried A. First single centre experiece in thoracic outlet syndrome. JSM Neurosurg Spine. 2015; 3:1055.
4. Sanders RJ, Hammond SL. Etiology and pathology. Hand Clin. 2004; 20:23–6.
crossref
5. Atasoy E. History of thoracic outlet syndrome. Hand Clin. 2004; 20:15–6.
crossref
6. Brantigan CO, Roos DB. Etiology of neurogenic thoracic outlet syndrome. Hand Clin. 2004; 20:17–22.
crossref
7. Ministry of Empolyment and Labor. 2014 Analysis of current industrial accidents. Sejong: Ministry of Empolyment and Labor;2015.
8. Abe M, Ichinohe K, Nishida J. Diagnosis, treatment, and complications of thoracic outlet syndrome. J Orthop Sci. 1999; 4:66–9.
9. Brantigan CO, Roos DB. Diagnosing thoracic outlet syndrome. Hand Clin. 2004; 20:27–36.
crossref
10. Sanders RJ, Haug CE. Thoracic outlet syndrome: a common sequela of neck injuries. Philadelphia: Lippincott;1991. p. 71–84.
11. Roos DB. The place for scalenectomy and first-rib resection in thoracic outlet syndrome. Surgery. 1982; 92:1077–85.
12. Sanders RJ, Monsour JW, Gerber WF, Adams WR, Thompson N. Scalenectomy versus first rib resection for treatment of the thoracic outlet syndrome. Surgery. 1979; 85:109–21.
13. Sanders RJ, Haug CE. Thoracic outlet syndrome: a common sequela of neck injuries. Philadelphia: Lippincott;1991. p. 95–104.
14. Kim KH, Kim KS, Kim DS, Jang SJ, Hong KH, Yoo SW. Characteristics of work-related musculoskeletal disorders in Korea and their work-relatedness evaluation. J Korean Med Sci. 2010; 25:77–86.
crossref
15. Park KS, Kang DM, Lee YH, Woo JH, Shin YC. Development of self administered questionnaire and validity evaluation for american national standards Z-365 checklist. J Korean Soc Occup Environ Hyg. 2006; 16:172–82.
16. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970; 2:92–8.
17. Sanders RJ, Haug CE. Thoracic outlet syndrome: a common sequela of neck injuries. Philadelphia: Lippincott;1991. p. 21–3.
18. Sanders RJ, Hammond SL, Rao NM. Thoracic outlet syndrome: a review. Neurologist. 2008; 14:365–73.
19. Wilbourn AJ, Porter JM. Neurogenic thoracic outlet syndrome: surgical versus conservative therapy. J Vasc Surg. 1992; 15:880–2.
crossref
20. Atasoy E. Combined surgical treatment of thoracic outlet syndrome: transaxillary first rib resection and transcervical scalenectomy. Hand Clin. 2004; 20:71–82.
crossref
21. Lee GW, Kwon YH, Jeong JH, Kim JW. The efficacy of scalene injection in thoracic outlet syndrome. J Korean Neurosurg Soc. 2011; 50:36–9.
crossref

Table 1.
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.

Table 2.
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.

a) No., duplication is possible according to work posture.

Table 3.
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.

Table 4.
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.

Table 5.
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.

TOOLS
Similar articles