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The Impact of Arm Dominance on Clinical and Surgical Outcomes in Patients Surgically Treated for Thoracic Outlet Syndrome
Amber Kernodle, MD MPH1, Amenah Dhannoon1, Husain Alshaikh, MD1, Martha Weaver, MD1, Holly Grunebach, PA-C1, Christopher J. Abularrage, MD1, James Black, III, MD1, Margaret Arnold, MD1, Thomas Reifsnyder, MD1, Julie Freischlag2, Ying Wei Lum, MD1.
1Johns Hopkins Hospital, Baltimore, MD, USA, 2UC Davis Heath, Sacramento, CA, USA.

Objective(s): Repetitive motion is associated with Thoracic Outlet Syndrome (TOS), but the impact of hand dominance has not been well studied. We conducted a retrospective chart review to determine whether hand dominance is related to presentation for surgical management and whether there is an association between hand dominance and outcomes after surgical decompression.
Methods: We identified all patients who underwent surgical decompression for TOS from 2003 to 2017. Hand dominance was defined as patients self-report of hand most often used to complete habitual, daily activities. We measured the frequency of TOS subtypes and known causes according to hand dominance. Nominal, post-surgical outcome variables included self-reported post-operative symptom resolution, vascular patency (ascertained by duplex ultrasound at 1 year), and complications (i.e. pneumothorax, infection, bleeding, vascular injury). Chi squared (X2) test was used to compare variables in non-dominant extremity TOS to dominant extremity TOS groups.
Results: We identified 655 patients with complete records who underwent surgery. Baseline characteristics were similar between groups. Of all TOS cases that were surgically treated, neurogenic and venous TOS comprised 60% and 35% respectively. Neurogenic TOS comprised a larger proportion of the non-dominant extremity cases (62% vs. 56%), while venous TOS was more prevalent on the dominant extremity (38% vs. 31%). The difference in subtype frequencies according to hand dominance, however, was not statistically significant. Patients with dominant extremity TOS presented earlier, with median symptom duration of 12 months, as compared to 18 months in non-dominant extremity cases. There was a significant difference in symptomatic improvement, with patients having dominant extremity TOS more often reporting relief (91% vs. 84%, p = 0.032). One-year venous patency was more common in dominant extremity venous TOS (93% vs. 84%, p = 0.044). Surgical complications, including pneumothorax, were not associated with hand dominance.
Conclusions: TOS (in particular, venous TOS) is more prevalent on the dominant extremity. Patients with TOS on their dominant extremity present earlier, more frequently report improvement in symptoms, and have a higher rate of venous patency.

Characteristics by Hand Dominance
Non-Dominant, N(%)Dominant, N(%)Total, N (%)p value
Type of TOS0.269
NTOS169 (61.5)214 (56.3)383 (58.5)
VTOS84 (30.5)143 (37.6)227 (34.7)
ATOS13 (4.7)14 (3.7)27 (4.1)
MIXED9 (3.3)9 (2.4)18 (2.7)
Improvement in Symptoms221 (85.3)329 (90.9)550 (88.6)0.032
Venous Patency76 (84.4)139 (92.7)215 (89.6)0.044


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