eMedicine Specialties > Neurology > Headache and Pain

Thoracic Outlet Syndrome: Follow-up

Author: Manish K Singh, MD, Assistant Professor, Pain Management, Department of Neurology, Drexel College of Medicine, Hahnemann University hospital
Coauthor(s): Jashvant Patel, MD, Medical Director, Department of Pain Medicine and Comprehensive Rehabilitation, Medical College of Pennsylvania Hahnemann University
Contributor Information and Disclosures

Updated: Nov 29, 2007

Follow-up

Further Inpatient Care

  • Hospitalization usually is not required for patients with TOS, but this decision depends on the invasiveness of the treatment choice for pain control and the severity of the patient's condition. Sometimes, a short hospitalization is necessary for individuals who require a continuous nerve block. Patients with TOS may have associated conditions that may be amenable to surgery and require further inpatient care.

Further Outpatient Care

  • Patients with TOS generally are treated on an outpatient basis and require a variety of health care professionals to manage their condition optimally. Please refer to the Treatment section for a discussion of proper rehabilitation methods and other treatment options.

Prognosis

  • Neurogenic TOC usually requires chronic pain management.
  • Vascular-type TOC may have better outcome with appropriate management.
  • Patients with profound intrinsic muscle atrophy do not regain their function. Appropriate surgery may arrest the progressive deterioration.

Patient Education

  • Instruct the patient on the following:
    • Good posture
    • Job modification
    • Exercise programs

Miscellaneous

Medicolegal Pitfalls

  • Recognizing secondary causes (especially space-occupying lesions) of brachial plexus compression is important.
    • Pancoast tumors can invade the thoracic outlet and compress the plexus.
    • Enlargement of the supraclavicular or axillary lymph nodes (due to metastasis or inflammation) can compress the brachial plexus.
    • Malunited clavicular fractures may result in callus overgrowth and compression of the brachial plexus.
 


More on Thoracic Outlet Syndrome

Overview: Thoracic Outlet Syndrome
Differential Diagnoses & Workup: Thoracic Outlet Syndrome
Treatment & Medication: Thoracic Outlet Syndrome
Follow-up: Thoracic Outlet Syndrome
References
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Further Reading

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Keywords

TOS, thoracic outlet syndrome, brachial plexus, neurologic TOS, vascular TOS, compression of the subclavian artery, compression of the subclavian vein, brachial plexus compression, congenital anomaly, arterial TOS, venous TOS, combined neurovascular TOS

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Contributor Information and Disclosures

Author

Manish K Singh, MD, Assistant Professor, Pain Management, Department of Neurology, Drexel College of Medicine, Hahnemann University hospital
Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Association of Physicians of Indian Origin, American Headache Society, American Medical Association, and American Society of Regional Anesthesia and Pain Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Jashvant Patel, MD, Medical Director, Department of Pain Medicine and Comprehensive Rehabilitation, Medical College of Pennsylvania Hahnemann University
Jashvant Patel, MD is a member of the following medical societies: Alberta Medical Association, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Society of Regional Anesthesia and Pain Medicine, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Medical Editor

Jorge E Mendizabal, MD, Consulting Staff, Corpus Christi Neurology
Jorge E Mendizabal, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, National Stroke Association, and Stroke Council of the American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James H Halsey, MD, Professor, Department of Neurology, University of Alabama Medical Center
James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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