Thoracic outlet syndrome: a controversial clinical condition. Part 2: non-surgical and surgical management

Abstract

Background: Proper management of thoracic outlet syndrome (TOS) requires an understanding of the underlying causes of the disorder. A comprehensive examination process, as described in Part 1 of this review, can reveal the bony and soft tissue abnormalities and mechanical dysfunctions contributing to an individual's TOS symptoms. Objective: Part 2 of this review focuses on management of TOS. Conclusion: The clinician uses clinical examination results to design a rehabilitation program that focuses on correcting specific problems that were previously identified. Disputed neurogenic TOS is best managed with a trial of conservative therapy before surgical treatment options are considered. Cases that are resistant to conservative treatment may require surgical intervention. True neurogenic TOS may require surgical intervention to relieve compression of the neural structures in the thoracic outlet. Surgical management is required for cases of vascular TOS because of the potentially serious complications that may arise from venous or arterial compromise. Post-operative rehabilitation is recommended after surgical decompression to address factors that could lead to a reoccurrence of the patient's symptoms.

Surgical and Functional Outcomes After Thoracic Outlet Syndrome Decompression via Supraclavicular Approach: A 10-Year Single Centre Experience

“…Although, all our cases had proven subclavian vessels involvement (stenosis or occlusion on arm abduction) on pre operative Duplex ultrasound scan, in principle they all were treated as nTOS. The recommended treatment involves a period of physiotherapy (4 -6 weeks) prior to any form of surgical decompression [5,14,15]. Physiotherapy manoeuvres such as postural exercises and the first rib mobilisation aim to reduce the pressure on the neurovascular structures within the thoracic outlet [16,17].…”

Thoracic-Outlet-Syndrom

“…"Die chirurgische Therapie des TOS verbessert die Lebensqualität" (Chang) Leider ist nicht nur das Fehlen einheitlicher verbindlicher Diagnostikstandards problematisch in der täglichen Routine [47,48]. Polvsen et al veröffentlichten 2014 einen Chochrane Review zum TOS und kamen zu dem ernüchternden Ergebnis, dass weder eine Evidenz für ein operatives oder konservatives Vorgehen vorliegt noch dass es eine Evidenz dafür gibt, welches operative Verfahren das bessere ist [49].…”

A Review Study: Clinical Assessment of Patients With Thoracic Outlet Syndrome

“…The factors which cause the compression in this area include congenital abnormalities associated with musculoskeletal structure, muscles, and other acquired factors [1,[3][4][5]. Depending on the structures under pressure, this syndrome categorizes into neurogenic thoracic outlet syndrome, vascular thoracic outlet syndrome, and disputed thoracic outlet syndrome [3,6].…”

“…Pain is one of the most common symptoms in these patients which can lead to clear and specific inability in performing daily activities [1,3]. Neurogenic and vascular thoracic outlet syndrome is primarily managed with surgical treatment and then non-surgical while the non-specified one is managed by non-surgical treatment and only those people who are resistant to nonoperative treatment, may need to have surgery [4]. Therefore, non-surgical treatment of thoracic outlet syndrome is one the most accepted treatments.…”