TOS Interventions

A rehabilitation program for thoracic outlet syndrome (TOS) should be designed based on results of the clinical examination that includes provocative testing. Effective treatment of TOS requires first identifying the underlying cause(s) of the neurovascular compression or tension. Failed attempts at conservative management may be related to improper or incomplete diagnosis of the underlying dysfunctions causing the patient’s symptoms (Hooper et. al., 2010).

General Approaches to the Management of TOS

Disputed Neurogenic TOS
A trial of conservative therapy should be attempted before surgical options are considered (Hooper et. al., 2010).
  • A review of 13 studies published between 1983 and 2001 found that good or very good results were achieved in 76 to 100% of disputed TOS patients within a month and 59 to 88% after at least one year (Vanti et. al, 2007).
True Neurogenic TOS
Conservative treatment is effective for the majority of patients (Hooper et. al., 2010). Surgical management is controversial and may be considered for patients with the following (Hooper et. al., 2010):
  • Weakness
  • Wasting of the hand intrinsic muscles
  • Nerve conduction velocity < 60 m/sec
  • Patients who fail a trial of conservative therapy and continue to experience significant pain limiting their ability to perform activities of daily living or work tasks
Arterial or Venous TOS
Surgical management is indicated because of the potentially serious complications that may arise from vascular compromise (Hooper et. al., 2010).