Thoracic Outlet Syndrome Follow-up

  • Author: Daryl A Rosenbaum, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Dec 2, 2011
 

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.

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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.

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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.

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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.

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Education

Inform patients that symptoms recur in 15-20% of patients.[45] 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.

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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.

Specialty Editor Board

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD  Professor of Medicine, Professor of Orthopedic Surgery, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, 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 Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

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Thoracic outlet syndrome in a 16-year-old volleyball player with a stenotic right subclavian vein (arrow) secondary to fibrosis.
 
 
 
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