Materiały źródłowe

• #1 Thoracic outlet syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/diagnosis-treatment/drc-20353994

  It’s important to have a correct diagnosis for a thoracic outlet as this will determine what type of therapy and treatment is implemented. […] So thoracic outlet syndrome can be assessed and managed by multiple health professionals. At Mayo Clinic, Florida, we have a multidisciplinary team that typically assesses, diagnoses, and then manages thoracic outlet. […] Absolutely. In fact, physical therapy and sports medicine can be used effectively in treating particularly neurogenic thoracic outlet syndrome. Usually it focuses on improving posture and posture correction, in addition to strengthening and stretching exercises. […] Treatment options for TOS varies based on the underlying cause and the type of the TOS neurogenic, vascular or non-specific. It’s crucial to customize the treatment based on the underlying cause and to have it tailored through a multidisciplinary approach.

• #2 How to truly identify and treat thoracic outlet syndrome (TOS) – MSK Neurology

  https://mskneurology.com/how-truly-treat-thoracic-outlet-syndrome/

  Diagnosis and treatment of thoracic outlet syndrome (TOS) involves neurologists, physiatrists, family physicians, orthopedic surgeons, vascular surgeons, thoracic surgeons, neurosurgeons and sometimes psychiatrists. Kknel, 2005 […] The most commonly recommended interventions are strengthening and stretching of the shoulder girdle musculature. However, little agreement exists on which muscles need strengthening and which ones need lengthening. These types of exercises do not detail how they address functional TOS as a result of respiratory alterations and they do not aim to inhibit muscle. Robey Boyle, 2009 […] Taking the research above into account, the reader can probably start to understand that its often very difficult to be properly diagnosed and treated if one has thoracic outlet syndrome. This article will shed light on what I consider a very effective approach to both diagnosis and treatment, that have cured thoracic outlet syndrome for most of our patients. Be aware though, that the actual treatment is a demanding procedure that will have to be managed through cooperation with a qualified therapist.

• #3 Thoracic Outlet Syndrome (TOS) | Ohio State Medical Center

  https://wexnermedical.osu.edu/heart-vascular/vascular-care/thoracic-outlet-syndrome

  Treatment of thoracic outlet syndrome varies greatly. The type of thoracic outlet syndrome you have will determine your treatment options. […] Your specialist may prescribe physical therapy, which includes stretching and neck-strengthening exercises. Your specialist may also prescribe muscle relaxers, anti-inflammatory drugs and pain relievers in addition to the physical therapy. […] Your specialist may prescribe clot-dissolving medication (thrombolysis) or anticoagulants (blood thinners). The goal is to dissolve clots and keep new clots from forming. […] If your condition interferes with daily living activities and does not improve with medication and therapy, your physician may recommend surgery. Thoracic outlet syndrome decompression surgery involves removing certain muscles from your neck or removing your first rib, and sometimes its necessary to remove both.

• #4 Thoracic Outlet Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557450/

  Thoracic outlet syndrome has two main classifications of treatment; conservative management or surgical intervention. It is common practice, and most physicians recommend, to attempt conservative management initially, except for patients with severe compression causing debilitating symptoms. […] Conservative management consists of lifestyle modifications, physical therapy (PT), and rehabilitation. Lifestyle modifications are crucial to treat and prevent future relapses. Postural correction is a common adjustment that can relieve patients symptoms. The way the patient sleeps also warrants attention, as they must avoid sleeping in overhead arm positions. If the patient uses repetitive motions at the workplace, preventative splints and pads are an option to provide support to relieve pressure.

• #5 Thoracic Outlet Syndrome (TOS): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17553-thoracic-outlet-syndrome-tos

  Thoracic outlet syndrome treatments vary, depending on the type of TOS you have and your symptoms. The goals of treatment are to reduce symptoms and prevent complications. Your provider will recommend the treatment option that’s right for you. […] Possible treatments include: […] Physical therapy: This is the most common initial treatment for neurogenic TOS. A physical therapist helps you increase your range of motion (how far you can move) in your neck and shoulders. Physical therapy also strengthens your muscles and promotes better posture. Most people with neurogenic TOS see an improvement in symptoms. […] Medications to relieve pain: Your provider may recommend over-the-counter pain relievers, such as NSAIDs. […] Medications to prevent or break up blood clots: Thrombolytic therapy helps people with arterial or venous TOS. You receive medication through an IV line or catheter that dissolves existing blood clots and prevent new ones from forming. Your provider may also prescribe anticoagulant medication.

• #6 Thoracic Outlet Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557450/

  Physical therapy is a mainstay as first-line treatment for patients suffering from TOS. For many patients, the cause of the condition is muscular imbalance. Physical therapy aims to strengthen the muscles around the thoracic outlet to relieve pressure on the impaired structures. Published studies have shown positive outcomes for patients who use this therapy to manage and alleviate their symptoms. […] In more severe cases of TOS, structural damage, or significant complications can occur, such as upper extremity DVTs or damage to blood vessels from compression. Once these complications receive treatment and resolve, the patient must undergo rehabilitation. Much like physical therapy, it aims at strengthening the muscles of the thoracic outlet, but it also encompasses regaining normal function if such function was lost. Even in patients with severe adverse events, conservative management is still the recommended first-line treatment.

• #7 Guide | Physical Therapy Guide to Thoracic Outlet Syndrome | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-thoracic-outlet-syndrome

  Thoracic outlet syndrome can be a painful and disabling condition of the upper extremity. It results from compression of structures in the space above the first rib and between the collar bone (clavicle). Due to varying signs and symptoms of TOS, the number of people with the condition is unknown. Physical therapists help people who have TOS to ease their symptoms and restore their upper body function. […] Physical therapists are movement experts who design treatment plans for each persons needs and goals. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. […] Based on their findings, your physical therapist will develop a customized rehabilitation program to help ensure a safe return to your desired activities. Some general treatment techniques may include:

• #8 Guide | Physical Therapy Guide to Thoracic Outlet Syndrome | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-thoracic-outlet-syndrome

  Your physical therapist will educate you about thoracic outlet syndrome to help you make decisions. Your physical therapist will work with you to identify and suggest changes to any factors causing your pain. […] Your physical therapist will design a program to address your pain that includes applying ice to the affected area. […] Your physical therapist may teach you self-stretching techniques to decrease tension and help restore normal motion of the affected joints. […] Your physical therapist may treat your condition by applying hands on treatments to gently move your muscles and joints. […] Based on your symptoms, your physical therapist will design a safe, progressive resistance program for you. […] Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities.

• #9 Thoracic Outlet Syndrome Physical Therapy: What to Expect

  https://www.verywellhealth.com/thoracic-outlet-syndrome-physical-therapy-5192098

  At a bare minimum, four to six weeks of PT are usually attempted before your physician would consider a more invasive injection or surgical intervention. That said, it may take up to four to six months of physical therapy to fully relieve the arm, hand, or finger symptoms you are experiencing. […] Following these surgical procedures, PT is generally necessary to help you recover and regain your function. […] During this time, it is important to protect the structures in the thoracic outlet area. Your physical therapist may also teach you different ways to sit or sleep that help reduce the chances that your pain levels increase. […] Ultimately, it can take up to six to nine months for a full return to higher-level exercise and sporting activities. […] Physical therapy for thoracic outlet syndrome typically focuses on three types of exercises. First, postural stretches are prescribed to improve the flexibility in the muscles that surround the affected nerves.

• #10 Thoracic Outlet Syndrome Physical Therapy: What to Expect

  https://www.verywellhealth.com/thoracic-outlet-syndrome-physical-therapy-5192098

  Next, nerve flossing or gliding techniques help free your nerves from any restrictions that are keeping them from moving normally. Finally, shoulder and shoulder blade strengthening activities help improve your posture, provide symptom relief, and prevent your TOS from recurring. […] The amount of time it takes for PT to help the symptoms of TOS varies from person to person. That said, it is not unusual to see progress in as little as four to six weeks. In some cases, however, it can take four to six months to completely resolve your symptoms. […] Depending on the activities you are looking to return to, rehab after a thoracic outlet syndrome surgery can last for six months or more.

• #11 Thoracic Outlet Syndrome Signs & Symptoms | Rush

  https://www.rush.edu/conditions/thoracic-outlet-syndrome

  RUSH vascular surgeons can help relieve your neck, arm or shoulder pain caused by thoracic outlet syndrome (TOS) through targeted physical therapy or surgery. […] Vascular surgeons at RUSH provide expert care for all types of TOS. They can diagnose and relieve symptoms unique to your TOS condition. […] Your first step in getting proper treatment is to discuss options with your RUSH provider. They may recommend a nonsurgical treatment, surgery or a combination to best manage your TOS symptoms. […] If you have neurogenic TOS, you may be able to get relief from your symptoms through physical therapy. Typically, physical therapy is the first part of your treatment plan. […] RUSH offers a three-month physical therapy treatment to help you manage your TOS symptoms. This treatment focuses on the following: Improving movement of your neck and shoulder. Strengthening your neck and shoulder muscles. Practicing better posture and body alignment so your muscles can work together most effectively. Breathing techniques, like diaphragmatic breathing, to help provide relief to muscles associated with breathing.

• #12 Neurogenic Thoracic Outlet Syndrome (TOS) | Center for Thoracic Outlet Syndrome | Washington University in St. Louis

  https://tos.wustl.edu/for-patients/neurogenic-thoracic-outlet-syndrome-tos/

  Neurogenic TOS is initially treated with physical therapy approaches to: […] It is important that the patient be referred to a therapist with experience, expertise and interest in TOS, since the management of this condition is different from that of other disorders affecting the neck, shoulder, spine and upper extremity. […] The physical therapist treating the patient with neurogenic TOS outlines a specific plan for initial treatment over a 4-6 week period, to be followed by physician reassessment. […] After the initial course of physical therapy, the physician will reassess the progress made and outline plans for future treatment. Most patients with mild symptoms of neurogenic TOS, or those in whom therapy has been started early after the onset of symptoms, will exhibit significant improvement.

• #13 Thoracic Outlet Syndrome > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/thoracic-outlet-syndrome

  Treatment includes physical therapy, lifestyle modifications, medications, surgery […] Fortunately, effective treatments are available for thoracic outlet syndrome, and most people with the condition have a good prognosis. […] Several treatment options are available for TOS, including: […] Physical therapy. Exercises and stretches targeting the muscles around the shoulder can strengthen them, as well as improve posture, muscle balance, and range of motion. Physical therapy can also help relieve symptoms by reducing the compression of blood vessels or nerves. […] Lifestyle changes. Activity modifications may help reduce symptoms and make symptoms occur less frequently. […] Medications. Several types of medications may help relieve symptoms, including: […] Muscle injections of a local anesthetic, steroids, or Botox (botulinum toxin) may also alleviate symptoms.

• #14

  https://umiamihealth.org/en/treatments-and-services/vascular-disease/thoracic-outlet-syndrome

  Medications Certain medications such as anti-inflammatory medicine, pain medicine, or muscle relaxants can be used to decrease inflammation, reduce pain, and relax muscles. […] Clot-Busting Medications If you have vascular thoracic outlet syndrome that has caused blood clots, your doctor may administer clot-busting medications (thrombolytics) directly into your veins or arteries to help break up the clots. After this, you may take a regular regimen of clot-preventing medication (anticoagulants). […] Thoracic Outlet Decompression If other treatments haven’t been effective for neurogenic thoracic outlet syndrome or if you have evidence of vascular thoracic outlet syndrome, your doctor may recommend you undergo surgery to relieve symptoms and complications related to thoracic outlet syndrome. There are several types of thoracic outlet decompression, but they all involve decreasing pressure on the affected nerves or blood vessels. It typically requires removal of the first thoracic rib and the anterior scalene muscle.

• #15 Thoracic outlet syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/diagnosis-treatment/drc-20353994

  If you have neurogenic thoracic outlet syndrome, physical therapy is the first line of treatment. The exercises strengthen and stretch your shoulder muscles to open the thoracic outlet. […] Injections of a local anesthetic, onabotulinumtoxinA (Botox) or a steroid medicine may be used to treat neurogenic thoracic outlet syndrome. The injections can help reduce pain.

• #16 Thoracic Outlet Syndrome: Causes, Symptoms, & Treatment

  https://centenoschultz.com/condition/thoracic-outlet-syndrome/

  Conservative options for TOS include modification of behaviors by avoiding activities that aggravate symptoms, and arm positions, along with physical therapy programs that strengthen the muscles of the pectoral girdle and help to restore normal posture. TOS can be treated successfully with simple physical therapy. […] Some patients respond well to medications for this. Pharmacologic interventions often provide symptomatic relief and primarily include analgesics (NSAIDs and/or opioids) for nerve pain, as well as muscle relaxants, anticonvulsants (anti-seizure drugs), and/or antidepressants. […] Additionally, injection of local anesthetic, steroids, or botulinum toxin type A into the anterior scalene and/or pectoralis muscle has demonstrated varying levels of success in observational studies.

• #17 Thoracic Outlet Syndrome: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/brain/thoracic-outlet-syndrome

  Management of TOS depends on the type. […] Neurogenic: The usual treatments are: […] Physical therapy: Youll do exercises to stretch and strengthen muscles in your neck and shoulders and improve your posture. This may be all you need to get relief. […] Medication: The doctor may recommend that you use a muscle relaxant or that you take ibuprofen or naproxen to ease pain and swelling. You may hear your doctor call these NSAIDS, or non-steroidal anti-inflammatory drugs. […] Botox shots: A shot into the muscle at the base of your neck can relax the area and help ease pain. This can work for up to 3 months and be repeated if you need it. […] Surgery is sometimes an option, but it doesnt work nearly as well for this type of TOS. […] Venous and arterial: First youll be treated for any possible blood clots. Then youll most likely need a type of surgery called thoracic outlet decompression. Your surgeon will open up the space for the nerves and blood vessels to pass through. They may remove extra bone or other tissue, and cut or remove muscles that are causing the compression. Theyll also fix or bypass damaged blood vessels.

• #18 Treatment for Thoracic Outlet Syndrome

  https://myhealth.umassmemorial.org/Library/Healthsheets/3,S,90567

  Treatment for thoracic outlet syndrome depends on whether the nerves, arteries, or veins are compressed. […] Treatments for thoracic outlet syndrome may be nonsurgical or surgical, and may include: […] Physical therapy to help strengthen shoulder muscles, improve posture, and enlarge the thoracic outlet space […] Botulinum toxin shots (injections) […] Surgical decompression, which may be removing a part of a muscle (anterior scalene), the first rib, or a fibrous band. […] You may have a poor response to nonsurgical treatment and a good response to Botulinum toxin shots. In that case, you may be a good candidate for surgical decompression.

• #19 Thoracic Outlet Syndrome Signs & Symptoms | Rush

  https://www.rush.edu/conditions/thoracic-outlet-syndrome

  If the scalene injection helps relieve your symptoms, this indicates you may be a good candidate for a scalenectomy. Your RUSH provider will help you decide if a scalenectomy is a good treatment for you. […] If you have venous or arterial TOS, your symptoms may be more advanced. In this case, your doctor will likely recommend surgery as the most effective treatment. […] Vascular surgeons are skilled in several surgical approaches to treat thoracic outlet syndrome. These procedures can help the nerves and blood vessels in your thoracic outlet work properly. […] RUSH offers the following surgical treatments: Surgeries for neurogenic TOS: First rib resection: Your surgeon removes a rib to make more room for compressed blood vessels and nerves. Scalenectomy: Your surgeon removes part of your scalene muscles (the three muscles on each side of your neck). This surgery also relieves compressed blood vessels and nerves and can prevent blood clots. Scalenectomy may be performed at the same time as a first rib resection.

• #20 Thoracic Outlet Syndrome: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/brain/thoracic-outlet-syndrome

  If other treatments dont fix your symptoms, you may need long-term pain management. You may need medication. […] Your doctor also may recommend a few things you can do to feel better: […] Get to a healthy weight. […] Set up your workstation to support good posture. […] Avoid things that aggravate the condition, like carrying a heavy bag on your shoulder. […] Take breaks often at work to move and stretch. […] Try a massage or a heating pad on your muscles. […] Do relaxation exercises, like visualization, autogenic relaxation (repeating a word that gives you peace), or progressive muscle relaxation (clinching then releasing different muscles).

• #21

  https://www.painscale.com/article/at-home-treatments-for-thoracic-outlet-syndrome

  Relaxation techniques allow the muscles to relax, which can reduce pain resulting from TOS. […] Several lifestyle changes can relieve symptoms of TOS. These include, but are not limited to, the following: Poor posture can result in TOS if the collarbones shifts and places pressure on nearby nerves. Proper posture can reduce pain associated with TOS. […] Weight and pressure on the shoulders, such as from a heavy bag, can worsen TOS. Avoid carrying and lifting heavy objects and repetitive movements that place stress on the thoracic area. […] Individuals who are overweight or obese should consider losing weight. Weight loss can relieve stress on joints and reduce symptoms associated with TOS.

• #22 Thoracic Outlet Syndrome Treatment & Management: Acute Phase, Recovery Phase, Maintenance Phase

  https://emedicine.medscape.com/article/96412-treatment

  Little argument exists against the surgical treatment of a patient with severe compression or compromise of the subclavian vein or artery. Likewise, patients with atrophy of the intrinsic muscles of the hand secondary to thoracic outlet syndrome with no distal sites of compression need surgical intervention. However, less severe cases are more controversial. […] Because of the high prevalence of surgical complications and variable reports of success, many surgeons offer surgery to patients with disputed or nonspecific-type thoracic outlet syndrome only as a last resort after prolonged conservative management and a detailed discussion regarding the risks and complications of surgery. […] Injection of botulinum toxin into the muscles of the thoracic outlet (scalenes, pectoralis minor, subclavius) has potential for obtaining long-term symptom relief, but further research is needed. A 2014 Cochrane review looked to evaluate outcome studies of treatments of TOS that took place at a minimum of 6 months after the intervention. The review found that there was very low quality evidence that transaxillary first rib resection decreased pain more than supraclavicular neuroplasty, and found no randomized evidence that either treatments is better than no treatment at all. […] Continued regular stretching of the muscles around the cervical girdle (eg, scalene, pectoralis major and minor, trapezius, levator scapulae, and sternocleidomastoid muscles) is essential. Recommended exercises for thoracic outlet syndrome include neck stretching, abdominal breathing, and postural exercises. […] To help prevent recurrence of thoracic outlet syndrome, the patient should avoid sleeping with his or her arms in an overhead position.

• #23 Thoracic Outlet Syndrome

  https://www.rwjbh.org/treatment-care/surgery/thoracic-surgery/thoracic-diseases-and-conditions/thoracic-outlet-syndrome/

  In most cases, a conservative approach to treatment is effective, especially if your condition is diagnosed early. Best results come from a combination of medical treatment and physical therapy. Treatment options may include: […] Avoid activities that worsen symptoms. […] Avoid carrying heavy bags over your shoulder. […] If you are overweight, talk to your doctor about weight-loss options. […] Maintain good posture. […] Take frequent breaks at work to move and stretch. […] Make and keep appointments to see your doctor for routine check-ups and follow-up tests. […] Thrombolytic therapy is the administration of drugs called lytics or clot busters that will help break up or dissolve blood clots. […] Anti-Inflammatory medications will help reduce inflammation and relief pain. […] Thoracic outlet decompression.

• #24 Thoracic outlet syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/diagnosis-treatment/drc-20353994

  The treatment for TOS varies based on the type of TOS, the severity of symptoms, and the underlying cause. But, broadly speaking, the pros for injections would be the fact that they are less invasive, they associate with less risk compared with surgery. […] Surgery can provide definitive treatment, long term result and can be tailored to the specific underlying cause in addressing the structural abnormalities. […] Your healthcare professional may recommend surgery if conservative treatments haven’t been effective. Or you might consider surgery if you experience ongoing or worsening symptoms. […] Thoracic outlet syndrome surgery has risks of complications, such as injury to the nerves, known as the brachial plexus. […] Surgery to treat thoracic outlet syndrome, called thoracic outlet decompression, may be done using several different approaches.

• #25 Thoracic Outlet Syndrome (TOS): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17553-thoracic-outlet-syndrome-tos

  Surgery: Most people with arterial or venous TOS need surgery. Some people with neurogenic TOS need surgery if other treatments don’t resolve symptoms. Surgeons use different methods depending on the type of TOS and your anatomy. For example, decompression surgery removes abnormal bone or tissue that’s causing compression. Other surgeries repair structural problems with your blood vessels to improve blood flow. Your provider will tell you if you need surgery and what it involves. They’ll also explain any possible risks. […] Don’t wait for your symptoms to go away. Seek medical care if you have symptoms of TOS. While in many cases, conservative measures like physical therapy alleviate symptoms, some people need surgery or other treatments to prevent serious complications. Your provider will tell you the treatment plan that’s appropriate for your needs.

• #26 Thoracic Outlet Syndrome (TOS) | University of Iowa Health Care

  https://uihc.org/services/thoracic-outlet-syndrome-tos

  Treatments for TOS vary, depending on the type of TOS you have and the severity of your symptoms. […] For many people with neurogenic TOS, symptoms can be managed with nonsurgical treatments. These include: […] Your provider may ask you to lose weight, avoid repetitive arm motions, or change the layout of your workspace to promote better posture. These steps may help naturally expand the space in the thoracic outlet, reducing compression on your nerves. […] Anti-inflammatory medicines like ibuprofen or naproxen sodium can reduce pain and inflammation if you have mild TOS. […] Our physical therapists can teach you exercises to strengthen your shoulder and neck muscles, which helps stabilize your collarbone. They can also help you improve your posture while standing and sitting. […] If your symptoms are too advanced and nonsurgical treatments don’t help—or if you have venous or arterial TOS, which have a higher risk of complications—your provider may recommend surgery.

• #27

  https://umiamihealth.org/en/treatments-and-services/vascular-disease/thoracic-outlet-syndrome

  Our group of vascular and thoracic surgeons are experts on all surgical approaches for thoracic outlet decompression, including robotic-assisted surgery. […] They select an approach that offers the best results: Supraclavicular approach: This method is used for arterial thoracic outlet syndrome that may require reconstruction of arteries. […] Transaxillary approach: Surgeons may use this procedure for venous thoracic outlet syndrome to avoid discomfort that can happen with robotic-assisted surgery, such as pain in the ribs or irritation from a chest tube. […] Robotic-assisted thoracoscopic surgery: Associated with better visualization of the entire 1st rib and thoracic outlet structures which could potentially represent lower risk of recurrence. This is a relatively new technique that may become the preferred approach for thoracic outlet decompression in the near future. Our thoracic surgeons are expert robotic surgeons.

• #28 Thoracic Outlet Syndrome | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/thoracic-outlet-syndrome

  Our multidisciplinary teams work together to offer highly individualized treatment, all in the best interest of patients with TOS. Surgical options include decompression surgery to remove the first rib via transaxillary, supraclavicular or infraclavicular approaches. […] The initial treatment includes a course of physical and occupational therapy focused on improving flexibility and to relieve tension and discomfort. If patients do not improve with therapy, thoracic outlet decompression is recommended. This involves removal of the first rib, surrounding muscle and scar tissue around the jugular and subclavian veins. […] Following surgery, patients have a short inpatient hospital stay and then are discharged home, active and able to perform daily activities. During the next few months, a comprehensive physical and occupational therapy program allows patients to resume unrestricted activity. Patients follow a pre-set medication taper regimen so they are off all post-operative medications by six months.

• #29 Thoracic Outlet Syndrome (TOS) | Ohio State Medical Center

  https://wexnermedical.osu.edu/heart-vascular/vascular-care/thoracic-outlet-syndrome

  Your surgeon may need to remove the blood clot surgically from your vein. If the vein has been badly damaged, your surgeon may need to repair it. […] Surgery is the only treatment option for arterial thoracic outlet syndrome. The surgeon must repair or replace your damaged artery and remove your abnormal rib in order to prevent damage from recurring.

• #30 Thoracic Outlet Syndrome Signs & Symptoms | Rush

  https://www.rush.edu/conditions/thoracic-outlet-syndrome

  Surgery for venous TOS: Thrombolysis: Your surgeon removes a blood clot to reopen your vein. This surgery can reduce arm swelling and blueish discoloration. […] Surgery for arterial TOS: Subclavian aneurysm repair: Your surgeon repairs an enlarged portion of your subclavian artery. This can prevent serious complications, like a stroke. […] After any of these surgeries, your surgeon may recommend another round of physical therapy to help improve your strength and activity level.

• #31 Thoracic Outlet Syndrome (TOS) | University of Iowa Health Care

  https://uihc.org/services/thoracic-outlet-syndrome-tos

  Different surgical procedures are used to treat different types of TOS. Our areas of expertise include: […] If you were born with an extra rib, or if your first rib bone is narrowing your thoracic outlet space, your surgeon may remove part or all of it. […] If certain neck muscles called scalene muscles compress your nerves or blood vessels, your surgeon may remove small pieces of those muscles. A scalenectomy is often performed with a rib resection. […] This procedure gets rid of blood clots caused by arterial or venous TOS. Your surgeon will either dissolve the clot by injecting medication into your vein or break up the clot and suction it out using a special machine. When a thrombolysis is necessary, it’s usually performed before moving forward with a rib resection or scalenectomy.

• #32 Thoracic Outlet Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557450/

  Surgical intervention is a controversial method of treatment. In patients with a severe compromise of the vasculature of atrophy of intrinsic muscles of the hand, surgery is the recommended approach. However, without credible and substantial evidence that TOS is the culprit, surgery is not recommended. Due to the nonspecific and vague nature of the symptoms, the majority of cases do not have this evidence. Physicians widely recommend against surgical intervention due to the imprecise diagnostic evidence and potential for complications from surgery. A study found the success rate of lower plexus surgical intervention being 75% while upper plexus was 50%. Another study demonstrated patients with nonspecific neurogenic TOS following surgical intervention reported work disability one year after surgery at 60% and 72.5% at 4.8 years.

• #33 Neurogenic Thoracic Outlet Syndrome (TOS) | Center for Thoracic Outlet Syndrome | Washington University in St. Louis

  https://tos.wustl.edu/for-patients/neurogenic-thoracic-outlet-syndrome-tos/

  In properly selected patients with neurogenic TOS who undergo supraclavicular decompression using the approach described here, we expect approximately 85% to have substantial improvement in symptoms within 3 months of the operation or earlier. […] Patients with neurogenic TOS who have not had improvement in symptoms following surgical treatment, in the absence of an alternative diagnosis, are considered to have persistent neurogenic TOS. […] Reoperation may be considered in all of these situations, to include resection of any residual scalene muscle, fibrous scar tissue around the brachial plexus, and any first rib remnant.

• #34 Thoracic outlet syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Thoracic_outlet_syndrome

  Physical therapy is often used before and after the operation to improve recovery time and outcomes. Potential complications include pneumothorax, infection, loss of sensation, motor problems, subclavian vessel damage, and, as in all surgeries, a very small risk of permanent serious injury or death.

• #35 Thoracic Outlet Syndrome: Symptoms & Treatment | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/heart-and-vascular-center/diseases-and-conditions/thoracic-outlet-syndrome

  Specific treatment for thoracic outlet syndrome varies depending on the type of TOS. Common strategies include physical therapy, pain medications, lifestyle changes, thrombolytic therapy and surgery. […] Specialists from the Brigham and Womens Heart and Vascular Center develop individualized treatment plans for patients based on: Age, Overall health, Medical history, Severity and form of the disease, Tolerance for specific medications or procedures, Expectations for course of the disease, Presence of other conditions. […] Specific treatment varies depending on the type of TOS and may include: Physical therapy, Pain medications, Lifestyle changes, Thrombolytic therapy, Surgery. […] Neurogenic Thoracic Outlet Syndrome Treatment: Physical therapy offers a common first treatment, Pain medications, such as ibuprofen, stronger pain medications or muscle relaxants, Lifestyle changes including improved posture, avoiding strenuous activities, avoiding repetitive activities and weight loss, Surgery is a final option if physical therapy and lifestyle changes don’t alleviate symptoms. Surgery can include cutting muscles or removing the cervical (first) rib.

• #36 Physical Therapy for Thoracic Outlet Syndrome | NYU Langone Health

  https://nyulangone.org/conditions/thoracic-outlet-syndrome/treatments/physical-therapy-for-thoracic-outlet-syndrome

  Treatment for neurogenic thoracic outlet syndrome typically begins with physical therapy. Experts at NYU Langones Rusk Rehabilitation provide therapy to reduce compression of arteries, veins, and nerves. Physical therapy can also strengthen muscles, improve flexibility, decrease pain, and promote good posture, which can decompress the brachial plexus. […] A doctor who specializes in rehabilitation medicine, called a physiatrist, evaluates your condition and creates a customized treatment plan. This may include stretching and endurance exercises, as well as electrical stimulation and heat to help improve blood flow. It may also involve manual manipulation and mobilization of the shoulder, chest, arms, or hands to release restricted soft tissue and muscle. […] Therapy may also involve occupational therapy, which can help you regain the mobility and strength in your shoulder and arm that is necessary to perform everyday tasks, such as getting dressed. This type of therapy may also include education about preventive measures, such as carrying lighter loads, taking frequent breaks from activities involving the upper body, and using proper posture to avoid straining the affected area. […] Your physical therapist teaches you exercises to perform at home between appointments. These movements can help improve your symptoms and prevent them from worsening.

• #37 Thoracic Outlet Syndrome: Symptoms & Treatment | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/heart-and-vascular-center/diseases-and-conditions/thoracic-outlet-syndrome

  Arterial Thoracic Outlet Syndrome Treatment: Medication (blood thinners) to treat clots, Surgery is commonly recommended and may require cutting muscles or removing the cervical rib, repairing arteries and rerouting blood around the compressed area or angioplasty. […] Venous Thoracic Outlet Syndrome Treatment: Medications to thin the blood and treat clots, Thrombolytic therapy to dissolve clots, Surgery may require cutting muscles or removing the cervical rib, repairing veins and arteries and rerouting blood around the compressed area or angioplasty. […] Thoracic outlet syndrome surgery is most common for arterial TOS but may be needed in other types, especially venous TOC. When physical therapy, medication and other therapies cannot relieve the compression or clotting in the thoracic outlet, surgery can create additional space in the area or repair blocked or damaged arteries and veins.

• #38 Thoracic Outlet Syndrome Treatment – Scripps Health

  https://www.scripps.org/services/vascular-disease-care/thoracic-outlet-syndrome

  Angioplasty and stenting is a minimally invasive procedure that uses a balloon-tipped catheter to first inflate the problem vein, then insert a tiny cylinder called a stent that keeps the vein propped open. Angioplasty with or without stenting can be used to treat venous TOS. […] Thrombolysis, also known as thrombolytic therapy, is used to dissolve a blood clot with medication injected directly into the vein. This procedure is usually used to treat venous TOS, and is sometimes paired with first rib resection or angioplasty and stenting.

• #39 Thoracic Outlet Syndrome | Heart and Vascular Care | UMass Memorial Health

  https://www.ummhealth.org/services-treatments/heart-and-vascular-care/vascular-endovascular-surgery/thoracic-outlet-syndrome

  If youre living with the pain, tingling and weakness of your arm, or if youve been diagnosed with a vein blood clot in your arm, its time to get help. […] At UMass Memorial Health, our vascular surgeons specialize in diagnosing and treating these uncommon conditions, known as thoracic outlet syndromes (TOS). […] You dont have to travel far for comprehensive care from a skilled team. […] Conservative treatments often ease TOS symptoms due to neurogenic TOS. We may recommend physical therapy, medication, changes to your daily activities or nerve blocks. If these are unsuccessful, surgery may be considered. […] Venous and arterial TOS are not treated with physical therapy; surgery is often considered for these conditions. […] Regardless of the type of TOS, when surgery is recommended, the key step is to surgically remove the rib that is causing the compression. […] For neurogenic TOS, the nerves must be freed from surrounding scar tissue. […] For venous TOS, the clot must be removed and the scarred portion treated. This can often be done with a minimally invasive procedure. […] For arterial TOS, the artery must be repaired or replaced surgically.

• #40 Thoracic Outlet Syndrome | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/thoracic-outlet-syndrome

  If the vein is clotted, patients typically undergo a clot-dissolving procedure to remove the vein obstruction and a workup to confirm the diagnosis. Occasionally, blood tests are required to rule out other causes of clotting. Following restoration of blood flow, surgery is performed in 2-6 weeks depending on results of the venogram. Surgery includes a complete anterior and middle scalenectomy, resection of the entire first rib and removal of the subclavius muscle. In some instances, intraoperative venography with reconstruction of the subclavian vein is needed. […] Following surgery, patients have a short inpatient hospital stay and then are discharged home, active and able to perform daily activities. During the next few months, a comprehensive physical and occupational therapy program to allow patients to resume unrestricted activity. Patients follow a pre-set medication taper regimen so that patients are off all post-operative medications by six months.

• #41 Thoracic Outlet Syndrome | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/thoracic-outlet-syndrome

  Patients who present with acute/subacute upper extremity ischemia will need restoration of blood flow through lysis or through open surgery followed by a thoracic outlet decompression with a complete anterior and middle scalenectomy, resection of the entire first rib and possible arterial reconstruction. Patients with an incidentally found pulsating mass, a subclavian aneurysm or arm claudication will need a thoracic outlet decompression and possible arterial reconstruction. […] Following surgery, patients have an inpatient hospital stay and then are discharged home, active and able to perform daily activities. During the next few months, a comprehensive physical and occupational therapy program allows patients to resume unrestricted activity. Patients follow a pre-set medication taper regimen such that patients are off all post-operative medications by six months.

• #42 Physical or Occupational Therapy in Cleveland for Thoracic Outlet Syndrome

  https://www.therapy-specialists.com/Injuries-Conditions/Shoulder/Shoulder-Issues/Thoracic-Outlet-Syndrome/a~373/article.html

  Your rehabilitation will likely be more complex after surgery. Patients wear a sling after surgery to support the shoulder and arm. Passive movements can begin soon after surgery. But there should be no active motion for about two weeks, to allow the soft tissues time to heal. […] Our TOS patients usually start doing resistive exercise and activities after three to four weeks. These treatments help improve motion in the shoulder blade and arm. Posture and strengthening exercises help prevent future TOS problems. […] Our Physical or Occupational Therapist will give special attention to the type of work you do, and may have suggestions to help you avoid work postures and activities that could cause problems. We’ll show you strategies to take care of any future symptoms and avoid further problems.

• #43 Thoracic Outlet Syndrome | Vascular Disease | Henry Ford Health – Detroit, MI

  https://www.henryford.com/services/vascular-disease/thoracic-outlet-syndrome

  If you have arterial thoracic outlet syndrome, our vascular surgeons oversee your care. Some people need a minimally invasive procedure from our interventional radiologists. But most people require surgery to relieve pressure on the affected arteries. Surgery to treat arterial thoracic outlet syndrome is highly effective, relieving symptoms about 95 percent of the time. Relieving pressure restores blood flow to your arm and avoids the risk of gangrene (tissue death) and limb loss. Treatment options for arterial thoracic outlet syndrome include: Anticoagulant medications: Blood thinners help prevent blood clots. Catheter-directed thrombolysis: If you have a blood clot in the compressed artery, our interventional radiology team performs a minimally invasive procedure to dissolve the clot. Thoracic outlet decompression surgery: Your vascular surgeon performs an open procedure to remove: The extra rib, if present, All or part of the first rib, Certain muscles in the neck.

• #44 Thoracic Outlet Syndrome (TOS)

  https://www.cincinnatichildrens.org/health/t/thoracic-outlet-syndrome

  After surgery, there is a therapy protocol to help patients in their return to activity. More than 85% of surgical patients return to prior activity level without symptoms. […] A referral to the Pain Clinic may be recommended to reduce pain symptoms. The goal is to make the pain manageable for daily activities and physical therapy. Cognitive behavioral therapy may be used as well to target nerve pain or muscle tightness. […] In addition to medications, the team may recommend injections such as nerve blocks including local anesthetics and steroids. Muscle injections of Botox may help reduce neuropathic pain symptoms. Comprehensive pain management may also include psychosocial support to promote coping skills.

• #45 Treatment for thoracic outlet syndrome | Cochrane

  https://www.cochrane.org/CD007218/NEUROMUSC_treatment-for-thoracic-outlet-syndrome

  We reviewed the evidence about the effect of any treatment for thoracic outlet syndrome (TOS). […] We searched widely for clinical trials of treatments for TOS. We wanted to discover whether any treatment is effective and whether treatments have any harmful effects. […] There is very low quality evidence that removal of a rib reduced pain from 'disputed’ TOS more than a neuroplasty procedure. […] There were no trials of surgery versus no treatment. The trial comparing the intervention of BTX injection with placebo provided moderate evidence that this procedure does not significantly reduce pain or disability scores long term, although there were no adverse events associated with the procedure over placebo. […] This systematic review demonstrated that there is not enough evidence that the established interventions for TOS are helpful in relieving pain. Until high quality, randomized clinical trials comparing the various interventions for TOS are performed, the decision whether to treat and the choice of appropriate treatment will have to be based on the preferences of the individual and health care provider.

• #46 Treatment for thoracic outlet syndrome | Cochrane

  https://www.cochrane.org/CD007218/NEUROMUSC_treatment-for-thoracic-outlet-syndrome

  There was very low quality evidence that transaxillary first rib resection decreased pain more than supraclavicular neuroplasty, but no randomized evidence that either is better than no treatment. […] There is moderate evidence to suggest that treatment with BTX injections yielded no great improvements over placebo injections of saline. […] There is a need for an agreed definition for the diagnosis of TOS, especially the disputed form, agreed outcome measures, and high quality randomized trials that compare the outcome of interventions with no treatment and with each other.

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