Conservative Management
Management of patients with thoracic outlet syndrome (TOS) with a long history of pain and disability requires an individualized approach. Initial treatment efforts should focus on symptom reduction. Early attempts to correct postural or biomechanical deformities should be approached cautiously in order to avoid an increase in symptoms (Hooper et. al., 2010).
Conservative treatment may involve a combination of any of the following (Hooper et. al., 2010):
Non-steroidal anti-inflammatory drugs
Injection of botulinum toxin into the anterior and middle scalenes
Modify aggravating postures or activities:
Injection of botulinum toxin into the anterior and middle scalenes
Modify aggravating postures or activities:
- Avoid sleeping with the arms in an abducted, overhead position.
- Reduce overhead activities.
- Avoid carrying heavy objects with the affected extremity.
- Restore normal arthrokinematics of surrounding joints
- Correct related muscle weaknesses and imbalances
- Improve nerve mobility