eMedicine Specialties > Sports Medicine > Spine
Thoracic Outlet Syndrome: Follow-up
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
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
Follow-up: Thoracic Outlet Syndrome