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My name is Ying Wei Lum.
I am a vascular surgeon at Johns Hopkins Hospital.
I treat patients with all facets of vascular disease including
thoracic disease peripheral arterial disease,
arterial aneurysms, vein disease,
hemodialysis access, and thoracic outlet syndrome.
One of my areas of expertise is in thoracic outlet syndrome,
because I did all my training here at Johns-Hopkins Hospital.
I had the privilege of working with Dr.
who trained me in the field thoracic outlet surgery.
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Thoracic outlet syndrome is a compressive syndrome that
happens in the thoracic outlet area which is
located right here.
The neurovascular structures that supply the arm and
the hand can be compressed sometimes in this area that is
bounded by the collarbone, the first rib, in some people,
the cervical rib.
And a couple of different muscles that border the thoracic
outlet area.
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Thoracic outlet syndrome is diagnosed depending on what
structure is being compressed.
If the septic vein is compressed then the patient would present
with a blood clot or otherwise known as a DVT.
During session assists that the patient will have a swollen arm
and sometimes even bluish discoloration of the entire arm.
If the structure that's been compressed is the subclavian
artery, sometimes patients will develop an aneurysm,
which can be diagnosed on ultrasound or CAT scan.
And also sometimes patients will have symptoms of
abnormalities in the hands, due to embolic disease.
The most difficult diagnosis is when the thoracic outlet air
compresses the brachial plexus, or the nerve in the area.
This happens in about 90% to 95% of all thoracic
outlet syndrome diagnoses.
And can be difficult to diagnose, and often,
patients have a long standing history of pain.
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There are many kinds of tests that need to be done in
the patient thoracic outlet syndrome,
and it also depends on what kind of compression structures
are being involved in the disease.
If the subcutaneous vein is compressed, and
we suspect a DBT, the patient should go to an IAC accredited
Vasco lab and get an ultrasound as their first step.
If the compression is the subcutaneous artery,
the first step can also often be a color duplex ultrasound in
the IAC accredited Vasco lab.
If it's a new genetic
thoracic outlet syndrome that we're dealing with,
then there are many other tests that have to be done.
We also do a vascular EP study on these patients, because we
feel that it can be predictive or suggestive of thoracic
outlet syndrome if there's compression in that area.
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The treatment options for thoracic outlet
syndrome depend on what structure's being compressed.
If it's a vein or the artery being compressed,
usually the treatment is surgical.
And the patient will have to undergo an operation for that.
If the diagnosis is compression of the nerves in thoracic outlet
syndrome, then the treatment can be killer to the patient.
Quiet often we first start with physical therapy.
And if there's successful then it's great.
The patient can be cured that way.
If it's not successful, then we have other test to take care of
the patient and diagnose and confirm the diagnosis of
thoracic outlet syndrome, before which we will recommend either
injections or surgery as a form of treatment.
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We tend to like to do an operation that goes through
the armpits with an incision about this long.
The operation takes anywhere between 45 minutes to a hour and
a half, and patients typically go home within 24 hours.
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Typically I tell patients that they're gonna feel a little bit
sore for a couple days after surgery.
But within the first one or
two weeks people should feel comfortable getting them through
things they used to do I always want patients not to do any
heavy lifting for several months after surgery.
We also start physical therapy about two weeks after surgery.
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I've taken care of patients who are professional athletes in
the collegiate level.
Patients usually are able to get back to doing the activities
that they used to do, especially if they're young and healthy.
It's very important that they do physical therapy after
the operation so that their recovery is smooth and they do
not form scar tissue in the area where the bone used to be.
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Thoracic outlet syndrome can be a tricky diagnosis sometimes,
and sometimes if patients have recurrence of the symptoms it's
because diagnosis was probably not the right one in
the first place.
However, if the compression is due to the subclavian artery or
vein being compressed by the thoracic area and we operate for
that reason this very unlikely to recur.
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One of the most rewarding things that I like to achieve when I
take care of patients with ALS syndrome is to see my patients
get back to doing activities that they used to be doing.
Off the top of my head,
I can think of one patient that used to have such debilitating
symptoms that she couldn't continue her classes in college.
And almost right after surgery she was able to go
back to school.
Another player had such debilitating symptoms that he
couldn't play hockey, which he loved a lot, and after the
surgery, within six months he was back playing hockey again.
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Johns Hopkins is a great place to get treated for
thoracic outlet syndrome because we have established protocols
starting from the clinic visit to the vascular lab.
To the operating room and in your recovery.
We have established physical therapy protocols that is
prescribed to hundreds of patients and
we know that it works well that way.
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