Post-Traumatic Thoracic Outlet Syndrome: Clinical Spectrum, Diagnostic Challenges, and Surgical Experience from a High-Trauma, Resource-Limited Setting

Background: Post-traumatic thoracic outlet syndrome (PT-TOS) arises from neurovascular compression following trauma to the neck or shoulder, leading to significant disability. Despite its prevalence in high-trauma regions, data from resource-limited settings remain scarce. Methods: A retrospective analysis was conducted on 400 consecutive patients (mean age 36.1 ± 9.5 years; 63.7% female) surgically treated for PT-TOS between October 2007 and October 2024. All underwent supraclavicular decompression with first-rib resection and scalenectomy. Functional outcomes were assessed using pre- and postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Recurrence-free survival and predictors of outcome were analyzed using Cox and multivariate regression models. Results: All patients had a history of trauma most commonly falls (27.3%), street fights (26.0%), or pedestrian injuries (24.8%). Mean DASH scores improved significantly from 54.8 ± 9.0 preoperatively to 9.8 ± 6.0 postoperatively (p < 0.001). Recurrence occurred in 30% of patients, predominantly mild and manageable. Cervical rib was the only independent predictor of recurrence (OR 1.50, 95% CI 1.05–2.10, p = 0.02), while higher baseline disability predicted greater postoperative improvement (β = +4.3, p = 0.001). No mortality or major complications were recorded, and mean hospital stay was one day. Conclusions: Supraclavicular decompression with first-rib resection and scalenectomy provides durable symptomatic and functional recovery in PT-TOS, even within resource-limited contexts. Early surgical referral and meticulous technique ensure optimal outcomes, with cervical rib representing the main anatomical determinant of recurrence.