eMedicine Specialties > Sports Medicine > Spine

Thoracic Outlet Syndrome: Follow-up

Author: Daryl A Rosenbaum, MD, Assistant Professor, Director of Sports Medicine Fellowship, Department of Family and Community Medicine, Wake Forest University School of Medicine; Team Physician, United States Soccer Federation
Coauthor(s): Matthew L Silvis, MD, Assistant Professor, Departments of Family and Community Medicine and Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine; Ajay Kalra, MD, Consulting Surgeon, Surgical Specialists; Matt Thornburg, MD, Staff Physician, Department of Family and Community Medicine, University of Missouri Health Care at Columbia; Donald Spadone, MD, Assistant Professor, Department of Surgery, Division of Vascular Surgery, University of Missouri Health Sciences Center
Contributor Information and Disclosures

Updated: Aug 15, 2008

Follow-up

Return to Play

Return to play following treatment of thoracic outlet syndrome is difficult to generalize and depends on multiple variables, including the type of thoracic outlet syndrome, the presence of contributing factors, the treatment plan, the response to treatment, and the sport played.

Complications

Ischemic changes, including gangrene, are potential complications of arterial thoracic outlet syndrome. Pulmonary embolism is reported in 0-28.5% of patients with subclavian-axillary venous thrombosis. Venous gangrene and upper extremity phlegmasia cerulea dolens account for 2-5% of all cases of phlegmasia. Nerve injury (eg, brachial plexus neurapraxia) is the most serious postoperative complication after thoracic outlet decompression. Bleeding problems from the subclavian vessels and lymph leakage from the thoracic duct occur infrequently.

Prevention

The patient should avoid repetitive motions, stressful lifting, and overhead work. Performing a regular exercise program for improving flexibility and strength is beneficial. Shoulder-elevating movements (eg, shrugs, hand circles) increase range of motion and aid in prevention, but they are not a treatment modality.

Prognosis

Symptoms resolve with conservative therapy in approximately 90% of individuals. Postsurgical success rates over 1 year vary from 43-78%. A good surgical result means improvement, not total cure. Most patients are able to return to their previous lifestyle without difficulty. Job modification is required in individuals who perform repetitive activities, work on assembly lines, perform heavy laboring, or work with their arms elevated.

Education

Inform patients that symptoms recur in 15-20% of patients.41 The initial treatment is conservative in nature and includes a search for other diagnoses (see Differentials and Other Problems to Be Considered). Chronic pain may improve with the continued use of analgesics and a routine exercise and strengthening program.

Miscellaneous

Medicolegal Pitfalls

  • Advise patients that surgical decompression may not completely alleviate all symptoms.
  • Recurrence is likely, if repetitive and overhead activities are continued.
  • All possible causes of symptoms should be excluded before surgical decompression of the thoracic outlet.

Related Medscape topics:
 Resource Center Medical Malpractice and Legal Issues
Specialty Site Surgery

 


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
Multimedia: Thoracic Outlet Syndrome
References
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Further Reading

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Keywords

thoracic outlet syndrome, aperture syndrome, TOS, nerve compression syndrome, vascular TOS, neurogenic TOS, disputed TOS, vascular thoracic outlet syndrome, neurogenic thoracic outlet syndrome, neurologic TOS, neurologic thoracic outlet syndrome, disputed thoracic outlet syndrome, nonspecific-type TOS, nonspecific TOS, nonspecific thoracic outlet syndrome, effort thrombosis

Paget-von Schrötter variant, Paget-Schroetter syndrome, Paget-von Schroetter syndrome, Paget-Schrötter syndrome, cervical rib syndrome, costoclavicular syndrome, scalenus syndrome, thoracic outlet compression syndrome, scalene triangle, costoclavicular space, pectoralis minor space, shoulder pain, arm pain, hand pain, arterial thoracic outlet syndrome, arterialTOS, venous thoracic outlet syndrome, venous TOS, thrombosis of the axillary-subclavian vein

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Contributor Information and Disclosures

Author

Daryl A Rosenbaum, MD, Assistant Professor, Director of Sports Medicine Fellowship, Department of Family and Community Medicine, Wake Forest University School of Medicine; Team Physician, United States Soccer Federation
Daryl A Rosenbaum, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine, North Carolina Medical Society, and Society of Teachers of Family Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Matthew L Silvis, MD, Assistant Professor, Departments of Family and Community Medicine and Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine
Matthew L Silvis, MD is a member of the following medical societies: American Academy of Family Physicians and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Ajay Kalra, MD, Consulting Surgeon, Surgical Specialists
Ajay Kalra, MD is a member of the following medical societies: Missouri State Medical Association
Disclosure: Nothing to disclose.

Matt Thornburg, MD, Staff Physician, Department of Family and Community Medicine, University of Missouri Health Care at Columbia
Matt Thornburg, MD is a member of the following medical societies: American Academy of Family Physicians and American Medical Association
Disclosure: Nothing to disclose.

Donald Spadone, MD, Assistant Professor, Department of Surgery, Division of Vascular Surgery, University of Missouri Health Sciences Center
Donald Spadone, MD is a member of the following medical societies: American College of Surgeons, American Institute of Ultrasound in Medicine, Association for Academic Surgery, Association for Surgical Education, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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