Thoracic Outlet Syndrome - Treatment

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What is the treatment for thoracic outlet syndrome?

Treatment of the thoracic outlet syndrome can usually be successful with conservative measures. Treatments include a variety of exercises that effectively stretch open the tissues of the thoracic outlet. These are done with and without weights in the hands to pull the outlet into a "relaxed" open position. Physical therapists are specially trained in the instruction of exercises for thoracic outlet syndrome, and their evaluation of the patient can be helpful. Shoulder-shrug exercises and others can be done at home or at work to relax the muscles around the thoracic outlet.

Patients should avoid prolonged positions with their arms held out or overhead. For example, it is best to avoid sleeping with the arm extended up behind the head. It is also helpful to have rest periods at work to minimize fatigue. Weight reduction can be helpful for obese patients. Patients should avoid sleeping on their stomach with their arms above the head. They should also not repetitively lift heavy objects.

Some patients with severe, resistant symptoms can require surgical operations to open the thoracic outlet. These procedures include removal (resection) of the first rib in order to spare injury to the affected nerve and blood vessels from ongoing compression.

Thoracic Outlet Syndrome At A Glance

  • Thoracic outlet syndrome is a condition whereby symptoms are produced from compression of nerves or blood vessels, or both, because of an inadequate passageway through an area (thoracic outlet) between the base of the neck and the armpit.
  • Symptoms include neck, shoulder, and arm pain, numbness, or impaired circulation to the extremities (causing discoloration).
  • Diagnosis of thoracic outlet syndrome is suggested by the symptoms and physical findings and is sometimes supported by electrical and/or radiology tests.
  • Treatment of thoracic outlet syndrome usually involves physical-therapy exercises and avoiding certain prolonged positions of the shoulder.

References:

Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.
Kelley's Textbook of Rheumatology, W B Saunders Co, edited by Shaun Ruddy, et al., 2000.

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Comment from: epc238, 45-54 Female (Patient) Published: May 02

I suffer from bilateral thoracic outlet syndrome (TOS), diagnosed a year ago. Nine to ten months ago I had surgery on the right side for TOS. I went to sleep for surgery with a fully functioning hand, and awakened to a brachial plexus injury, severely limiting use of my hand. Although I could make a fist, there is no strength behind it. I couldn't even squeeze play dough or hold a toothbrush. Turns out I did have cervical rib. I have pain on the surgical side on a daily basis, ranging from neck, shoulder blade, arm, hand, shoulder, and sometimes radiating into my ear. I have more frequent pain now than before the surgery. Sleeping is an issue. Nine plus months later, I have half my grip strength back, and zero pinch strength (thumb and index). I'm awaiting a second opinion before undergoing surgery for the other side. I have noticed my arm/hand on surgical side don't fatigue as easily now, but I'm not sure if I feel it was worth it. I'd most definitely do your homework and request a second opinion prior to surgery.

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Comment from: Lisa, 45-54 Female (Patient) Published: January 27

After finally getting a diagnosis of thoracic outlet syndrome and being frustrated with standard physical therapy that would always cause my arm and fingers to go numb, I finally found out about Egoscue postural therapy. It is making a huge difference and I will not need to go under the knife for this condition.

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