Effective treatment of thoracic outlet syndrome: A Synthesis of Findings from 26 Studies

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Original Abstract of the Article

Major research findings

Thoracic outlet syndrome (TOS) is a condition that occurs when the nerves or blood vessels in the space between your collarbone and your first rib are compressed. 5 This can cause pain, numbness, tingling, or weakness in your arm, hand, or fingers. 5 TOS can be caused by a variety of factors, including anatomical abnormalities, repetitive motions, trauma, and certain medical conditions. 3 The most common type of TOS is neurogenic TOS, which occurs when the nerves in your neck and shoulder are compressed. 3 Arterial TOS, which occurs when the arteries in your neck and shoulder are compressed, is less common. 5 There is no one-size-fits-all treatment for TOS, and the best treatment for you will depend on the severity of your symptoms and the underlying cause of your condition. 21 Treatment options for TOS include physical therapy, medications, and surgery. 21

Treatment summary

There are many treatment options for TOS, including:

  • Physical therapy: Physical therapy can help to improve your posture, strengthen your muscles, and increase your range of motion. 21
  • Medications: Medications can help to reduce pain and inflammation. 21
  • Surgery: Surgery is an option for patients who do not improve with conservative treatment. 21 Surgery involves removing the first rib or other structures that are compressing the nerves or blood vessels. 16

In the case of TOS, a 2021 study showed that surgery was more effective than conservative treatment for TOS symptoms. 10

Benefits and Risks

Benefits summary

The benefits of TOS treatment include:

  • Reduced pain, numbness, and tingling
  • Improved range of motion and function
  • Improved quality of life

Risks summary

The risks of TOS treatment include:

  • Infection
  • Nerve damage
  • Blood clots

Comparison of studies

Commonalities

Many studies have shown that a variety of treatments, such as surgery and conservative treatment, are being used to relieve TOS symptoms. 4

Differences

Some studies have compared the effectiveness of different treatments, suggesting that different treatments may be more appropriate for specific patient groups. 4 For example, surgery may be more effective in patients with severe neurological symptoms. 4

Consistency and contradictions in results

Research findings on the treatment of TOS have both consistencies and contradictions. 21 For example, some studies have shown that surgery is effective, while others question the effectiveness of surgery. 21 This contradiction may be due to factors such as research design and participant characteristics. 21

Caveats for real-life application

Research findings on the treatment of TOS may not be applicable to all patients. 21 Various factors such as the patient's condition and symptoms, lifestyle, and physical activity level can influence the choice of treatment. 21 Therefore, it is important to consult with your doctor to choose the right treatment for you. 21

Limitations of current research

Research on the treatment of TOS is still insufficient. 21 In particular, there is no clear consensus on the need for surgery, the type of surgery, or specific criteria for patients suitable for surgery. 21 Therefore, further research is needed. 21

Future research directions

Future research should further evaluate the effectiveness and safety of treatment options for TOS. 21 It is also important to investigate whether specific treatments are suitable for specific patient groups. 21

Conclusion

TOS is a condition that can affect the nerves or blood vessels in the space between your collarbone and your first rib. 5 This can cause pain, numbness, tingling, or weakness in your arm, hand, or fingers. 5 There is no one-size-fits-all treatment for TOS, and the best treatment for you will depend on the severity of your symptoms and the underlying cause of your condition. 21 If you are experiencing any symptoms of TOS, it is important to see a doctor for diagnosis and treatment. 21

Treatment list

Physical therapy, medications, surgery

Literature analysis of 26 papers
Positive Content
24
Neutral Content
0
Negative Content
2
Article Type
3
2
6
5
23
2.

Modern Treatment of Neurogenic Thoracic Outlet Syndrome: Pathoanatomy, Diagnosis, and Arthroscopic Surgical Technique.

Author: AhmedAdil S, LafosseThibault, GrafAlexander R, KarzonAnthony L, GottschalkMichael B, WagnerEric R

Thoracic outlet syndrome treatment

This abstract discusses the diagnosis and management of neurogenic thoracic outlet syndrome, highlighting the importance of understanding its anatomy, kinematics, and the role of pectoralis minor syndrome.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

4.

Considerations for Surgical Treatment of Neurogenic Thoracic Outlet Syndrome: A Meta-Analysis of Patient-Reported Outcomes.

Author: BlondinMario, GarnerGarrett L, HonesKeegan M, NicholsDavid Spencer, CoxElizabeth A, ChimHarvey

Improved functional outcomes

This systematic review and meta-analysis compares patient-reported functional outcomes following different surgical approaches for neurogenic thoracic outlet syndrome (nTOS).

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

5.

Functional outcome of arterial thoracic outlet syndrome treatment.

Author: de KleijnRobert J C M F, SchroppLudo, WesterinkJan, van HattumEline S, PetriBart-Jeroen, de BorstGert J

ATOS treatment

This study reports on a single center experience with the treatment of Arterial Thoracic Outlet Syndrome (ATOS) and evaluates the midterm patient-reported outcome.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

6.

Novel Diagnostic and Treatment Techniques for Neurogenic Thoracic Outlet Syndrome.

Author: WagnerEric R, GottschalkMichael B, AhmedAdil Shahzad, GrafAlexander R, KarzonAnthony L

Improved neurogenic thoracic outlet syndrome treatment

This study presents a diagnostic and surgical approach for neurogenic thoracic outlet syndrome. Ultrasound-guided injections are used to confirm the diagnosis, and arthroscopic surgical release is indicated for patients who fail physical therapy.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

8.

Treatment of Thoracic Outlet Syndrome Complications Assisted with a Cerebral Embolism Protection Device.

Author: Ansuategui-VicenteMarina, Tapia-LopezYolanda, Cases-PerezCristina, Ibarra-SanchezGabriela, GutierrezAnia Garcia, Gonzalez-FajardoJose-Antonio

Ischemia treatment
Stroke treatment
Cervical rib

This case report describes a 27-year-old female with stroke and upper limb ischemia due to a right cervical rib and retrograde thromboembolization. The patient underwent successful thrombectomy, internal carotid artery stenting, and transbrachial embolectomy with a cerebral protection device. The cervical rib was surgically removed to prevent further events.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

9.

Hydrodissection for the Treatment of Vascular Thoracic Outlet Syndrome.

Author: Ver HoefJohn M, ClearfieldDaniel

vTOS treatment
vTOS symptoms

This case report explored the effectiveness of hydrodissection for treating vascular thoracic outlet syndrome (vTOS). The study aimed to demonstrate the potential of this treatment modality for alleviating symptoms and preventing the need for surgery.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

10.

Surgery Versus Continued Conservative Treatment for Neurogenic Thoracic Outlet Syndrome: the First Randomised Clinical Trial (STOPNTOS Trial).

Author: GoeteynJens, PesserNiels, HoutermanSaskia, van SambeekMarc R H M, van NuenenBart F L, TeijinkJoep A W

NTOS treatment

Neurogenic thoracic outlet syndrome (NTOS) is a condition that affects nerves in the shoulder and neck, but it's not fully understood. While surgery has been shown to help some people, more research is needed. This study aims to objectively evaluate the effects of a procedure called thoracic outlet decompression (TOD).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

11.

Evaluation of Quality of Life after Surgical Treatment of Thoracic Outlet Syndrome.

Author: AmmiMyriam, HersantJeanne, HenniSamir, DaligaultMickael, PaponXavier, AbrahamPierre, PicquetJean

Improved quality of life
Reduced arm
shoulder
and hand disability

This prospective observational study found that surgical management of thoracic outlet syndrome (TOS) significantly improves quality of life in the short and medium terms. Patients showed improvement in Disability of the Arm, Shoulder, and Hand (DASH) scores and Short-Form 12 (SF-12) scores, indicating improvements in both physical and mental health.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.

Language : English

13.

Surgical treatment of thoracic outlet syndrome in pediatrics.

Author: BoglioneMariano, OrtízRamiro, TepliskyDarío, GiuseppucciCarlos, KormanLuciano, ReusmannAixa, BarrenecheaMarcelo

TOS surgical management

This review presents the authors' experience with the surgical management of thoracic outlet syndrome (TOS) in pediatric patients. Conservative management is the first-line treatment, but surgery may be necessary in cases that do not respond to conservative approaches.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

14.

Robotic-Assisted Thoracoscopic Resection of the First Rib for Vascular Thoracic Outlet Syndrome: The New Gold Standard of Treatment?

Author: ZehnderAdrian, LutzJon, DornPatrick, MinerviniFabrizio, KestenholzPeter, GelpkeHans, SchmidRalph A, KocherGregor J

Improved outcomes
Minimally invasive

This study describes a robotic approach for first rib resection for thoracic outlet syndrome (TOS) using a completely portal technique. The approach provides excellent exposure and is less invasive than traditional methods.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

15.

Neurogenic Thoracic Outlet Syndrome in Athletes - Nonsurgical Treatment Options.

Author: WarrickAlexandra, DavisBrian

Neurogenic thoracic outlet syndrome

This article reviews neurogenic thoracic outlet syndrome (NTOS) in athletes, particularly those who perform repetitive overhead activities. It covers the etiology, diagnosis, treatment, and return to sport considerations for athletes with NTOS.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

16.

Surgical treatment of cervical rib-associated arterial thoracic outlet syndrome.

Author: da SilvaElpidio Ribeiro, DalioMarcelo Bellini, SantarosaMarco Bianco, OliveiraTércio Ferreira, RibeiroMaurício Serra, JovilianoEdwaldo Edner

Thoracic outlet syndrome

This article describes two cases of arterial thoracic outlet syndrome, a rare condition associated with anatomic anomalies. The cases presented with different clinical manifestations: microembolization and aneurysm. Both cases were successfully treated surgically.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

19.

Performance in major league baseball pitchers after surgical treatment of thoracic outlet syndrome.

Author: J GutmanMichael, GutmanBrian S, D JoyceChristopher, M KirschJacob, B ShermanMatthew, NamdariSurena

Return to play

74% of professional pitchers who undergo surgical intervention for thoracic outlet syndrome (TOS) were able to return to play at the Major League Baseball level. The majority of pitching metrics were unchanged from prior to surgery.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

20.

Surgical treatment of thoracic outlet syndrome: a randomized trial comparing two operations.

Author: ShethRishi N, CampbellJames N

Improved thoracic outlet syndrome treatment
Thoracic outlet syndrome

This study compares the outcomes of two surgical approaches for thoracic outlet syndrome (TOS) in patients whose primary symptom is pain: supraclavicular neuroplasty of the brachial plexus (no rib removal) and transaxillary first rib resection.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

21.

Treatment for thoracic outlet syndrome.

Author: PovlsenBo, BelzbergAllan, HanssonThomas, DorsiMichael

Pain reduction
No adverse effects

Transaxillary first rib resection was shown to decrease pain more effectively than supraclavicular neuroplasty in patients with thoracic outlet syndrome (TOS). However, the evidence was of very low quality due to a lack of standardized diagnostic criteria and limited randomized trials.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

22.

Outcomes of Surgical Management of Neurogenic Thoracic Outlet Syndrome: A Systematic Review and Bayesian Perspective.

Author: YinZhong Gang, GongKe Tong, ZhangJian Bing

Improved TOS treatment

This review examines the outcomes of three surgical procedures for neurogenic thoracic outlet syndrome (TOS): transaxillary first rib excision (TAFRE), supraclavicular first rib excision with scalenectomy (SCFRE), and supraclavicular release leaving the first rib intact (SCR).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

23.

Surgery Versus Continued Conservative Treatment for Neurogenic Thoracic Outlet Syndrome: the First Randomised Clinical Trial (STOPNTOS Trial).

Author: GoeteynJens, PesserNiels, HoutermanSaskia, van SambeekMarc R H M, van NuenenBart F L, TeijinkJoep A W

NTOS treatment

Neurogenic thoracic outlet syndrome (NTOS) is a condition that affects nerves in the shoulder and neck, but it's not fully understood. While surgery has been shown to help some people, more research is needed. This study aims to objectively evaluate the effects of a procedure called thoracic outlet decompression (TOD).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

24.

Thoracic Outlet Syndrome Part II: Consensus on the Management of Neurogenic Thoracic Outlet Syndrome by the European Association of Neurosurgical Societies' Section of Peripheral Nerve Surgery.

Author: RochkindShimon, FerraresiStefano, DenisovaNatalia, GarozzoDebora, HeinenChristian, AlimehmetiRidvan, CaponeCrescenzo, BaroneDamiano G, ZdunczykAnna, PedroMaria T, AntoniadisGregor, KaiserRadek, DubuissonAnnie, PondaagWillem, KretschmerThomas, RasulicLukas, DenglerNora F

Thoracic outlet syndrome treatment

This consensus statement discussed the management of neurogenic thoracic outlet syndrome (nTOS), highlighting the lack of high-level evidence for treatment approaches.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

25.

Considerations for Surgical Treatment of Neurogenic Thoracic Outlet Syndrome: A Meta-Analysis of Patient-Reported Outcomes.

Author: BlondinMario, GarnerGarrett L, HonesKeegan M, NicholsDavid Spencer, CoxElizabeth A, ChimHarvey

Improved functional outcomes

This systematic review and meta-analysis compares patient-reported functional outcomes following different surgical approaches for neurogenic thoracic outlet syndrome (nTOS).

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

26.

Thoracic outlet syndrome in females: A systematic review.

Author: CralleLauren E, HarrisLinda M, LumYing Wei, DeerySarah E, HumphriesMisty D

TOS treatment

Thoracic outlet syndrome (TOS) occurs when nerves, veins, or arteries are compressed in the area where the neck and shoulder meet. While TOS is thought to be more common in women, there's limited research on how the condition affects men and women differently. This study will examine how men and women experience different types of TOS, including the symptoms, treatment, and outcomes.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

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