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Thoracic Outlet Syndrome Medication

  • Author: Daryl A Rosenbaum, MD; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Sep 13, 2015
 

Medication Summary

Acute findings of ischemia or thrombosis require immediate evaluation and anticoagulation.

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Anticoagulants

Class Summary

Anticoagulants are used to treat acute arterial or venous occlusion.

Heparin

 

Potentiates antithrombin III and prevents conversion of fibrinogen to fibrin. Inhibits thrombogenesis.

Warfarin (Coumadin)

 

Interferes with hepatic synthesis of vitamin K–dependent coagulation factors. Tailor dose to maintain an INR in the range of 2-3.

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Analgesics

Class Summary

The use of analgesics may aid in relieving the discomfort of an acute occlusion of the vascular structures or nervous impingement.

Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)

 

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, those with upper GI disease, and those who are taking oral anticoagulants.

Ibuprofen (Motrin, Ibuprin)

 

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Acetaminophen and codeine (Tylenol #3)

 

Oral analgesic indicated for treatment of moderate pain.

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Fibrinolytic Agent

Class Summary

Thrombolytics are used to promote fibrinolysis of intraluminal thrombus or embolus in occluded vessels.

Urokinase (Activase)

 

Direct plasminogen activator that acts on endogenous fibrinolytic system and converts plasminogen to the enzyme plasmin, which, in turn, degrades fibrin clots, fibrinogen, and other plasma proteins. The advantage is that the agent is nonantigenic.

Most often used for local fibrinolysis of thrombosed catheters and superficial vessels. When used for local fibrinolysis, urokinase is given as local infusion directly into the area of thrombus and with no bolus given.

The dose should be adjusted to achieve clot lysis or patency of the affected vessel.

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Contributor Information and Disclosures
Author

Daryl A Rosenbaum, MD Associate Professor, Director of Sports Medicine Fellowship, Department of Family and Community Medicine, Wake Forest University School of Medicine

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

Disclosure: Nothing to disclose.

Coauthor(s)

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, American Medical Association

Disclosure: Nothing to disclose.

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, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, 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, American Medical Society for Sports Medicine

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, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

References
  1. Arthur LG, Teich S, Hogan M, Caniano DA, Smead W. Pediatric thoracic outlet syndrome: a disorder with serious vascular complications. J Pediatr Surg. 2008 Jun. 43(6):1089-94. [Medline].

  2. Sadat U, Weerakkody R, Varty K. Thoracic outlet syndrome: an overview. Br J Hosp Med (Lond). 2008 May. 69(5):260-3. [Medline].

  3. Kaymak B, Ozçakar L, Inanici F, et al. Forearm bone mineral density measurements in thoracic outlet syndrome. Rheumatol Int. 2008 Jul. 28(9):891-893. [Medline].

  4. Oates SD, Daley RA. Thoracic outlet syndrome. Hand Clin. 1996 Nov. 12(4):705-18. [Medline].

  5. Teddy PJ, Johnson RD, Cai RR, Wallace D. Surgery for paediatric thoracic outlet syndrome. J Clin Neurosci. 2011 Nov 1. [Medline].

  6. Cuetter AC, Bartoszek DM. The thoracic outlet syndrome: controversies, overdiagnosis, overtreatment, and recommendations for management. Muscle Nerve. 1989 May. 12(5):410-9. [Medline].

  7. Roos DB. Thoracic outlet syndrome is underdiagnosed. Muscle Nerve. 1999 Jan. 22(1):126-9; discussion 137-8. [Medline].

  8. Wilbourn AJ. Thoracic outlet syndrome is overdiagnosed. Muscle Nerve. 1999 Jan. 22(1):130-6; discussion 136-7. [Medline].

  9. Urschel HC Jr, Patel AN. Surgery remains the most effective treatment for Paget-Schroetter syndrome: 50 years' experience. Ann Thorac Surg. 2008 Jul. 86(1):254-60; discussion 260. [Medline].

  10. Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurgery. 2004 Oct. 55(4):897-902; discussion 902-3. [Medline].

  11. Safran MR. Nerve injury about the shoulder in athletes. Part 2: long thoracic nerve, spinal accessory nerve, burners/stingers, thoracic outlet syndrome. Am J Sports Med. 2004 Jun. 32(4):1063-76. [Medline].

  12. Parziale JR, Akelman E, Weiss AP, Green A. Thoracic outlet syndrome. Am J Orthop. 2000 May. 29(5):353-60. [Medline].

  13. Rutherford RB, Cronewett JL, Gloviczki P. Vascular Surgery. 5th ed. Philadelphia, Pa: WB Saunders Co; 2000. 1184-1219.

  14. Moore WS, ed. Vascular Surgery: A Comprehensive Review. 4th ed. Philadelphia, Pa: WB Saunders Co; 1993. 600-3.

  15. Mackinnon SE, Novak CB. Thoracic outlet syndrome. Curr Probl Surg. 2002 Nov. 39(11):1070-145. [Medline].

  16. Hood DB, Kuehne J, Yellin AE, Weaver FA. Vascular complications of thoracic outlet syndrome. Am Surg. 1997 Oct. 63(10):913-7. [Medline].

  17. Rayan GM. Lower trunk brachial plexus compression neuropathy due to cervical rib in young athletes. Am J Sports Med. 1988 Jan-Feb. 16(1):77-9. [Medline].

  18. Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Am J Surg. 1976 Dec. 132(6):771-8. [Medline].

  19. Esposito MD, Arrington JA, Blackshear MN, Murtagh FR, Silbiger ML. Thoracic outlet syndrome in a throwing athlete diagnosed with MRI and MRA. J Magn Reson Imaging. 1997 May-Jun. 7(3):598-9. [Medline].

  20. Al-Shekhlee A, Katirji B. Spinal accessory neuropathy, droopy shoulder, and thoracic outlet syndrome. Muscle Nerve. 2003 Sep. 28(3):383-5. [Medline].

  21. Fujita K, Matsuda K, Sakai Y, Sakai H, Mizuno K. Late thoracic outlet syndrome secondary to malunion of the fractured clavicle: case report and review of the literature. J Trauma. 2001 Feb. 50(2):332-5. [Medline].

  22. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973 Aug 18. 2(7825):359-62. [Medline].

  23. Urschel HC Jr, Razzuk MA. Neurovascular compression in the thoracic outlet: changing management over 50 years. Ann Surg. 1998 Oct. 228(4):609-17. [Medline]. [Full Text].

  24. Wood VE, Twito R, Verska JM. Thoracic outlet syndrome. The results of first rib resection in 100 patients. Orthop Clin North Am. 1988 Jan. 19(1):131-46. [Medline].

  25. Novak CB, Mackinnon SE, Patterson GA. Evaluation of patients with thoracic outlet syndrome. J Hand Surg [Am]. 1993 Mar. 18(2):292-9. [Medline].

  26. Lee PP, Dorsi MJ, Belzberg AJ, Chhabra A. Magnetic resonance neurography-surgical correlation of neurologic thoracic outlet syndrome. Microsurgery. 2011 Nov. 31(8):662-5. [Medline].

  27. Machleder HI, Moll F, Nuwer M, Jordan S. Somatosensory evoked potentials in the assessment of thoracic outlet compression syndrome. J Vasc Surg. 1987 Aug. 6(2):177-84. [Medline].

  28. Komanetsky RM, Novak CB, Mackinnon SE, et al. Somatosensory evoked potentials fail to diagnose thoracic outlet syndrome. J Hand Surg [Am]. 1996 Jul. 21(4):662-6. [Medline].

  29. Sanders RJ, Hammond SL. Venous thoracic outlet syndrome. Hand Clin. 2004 Feb. 20(1):113-8, viii. [Medline].

  30. Melby SJ, Vedantham S, Narra VR, et al. Comprehensive surgical management of the competitive athlete with effort thrombosis of the subclavian vein (Paget-Schroetter syndrome). J Vasc Surg. 2008 Apr. 47(4):809-20; discussion 821. [Medline].

  31. Machleder HI. Evaluation of a new treatment strategy for Paget-Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein. J Vasc Surg. 1993 Feb. 17(2):305-15; discussion 316-7. [Medline].

  32. Urschel HC Jr, Razzuk MA. Paget-Schroetter syndrome: what is the best management?. Ann Thorac Surg. 2000 Jun. 69(6):1663-8; discussion 1668-9. [Medline].

  33. Patton GM. Arterial thoracic outlet syndrome. Hand Clin. 2004 Feb. 20(1):107-11, viii. [Medline].

  34. Dale WA, Lewis MR. Management of thoracic outlet syndrome. Ann Surg. 1975 May. 181(5):575-85. [Medline]. [Full Text].

  35. Sucher BM. Ultrasonography-guided osteopathic manipulative treatment for a patient with thoracic outlet syndrome. J Am Osteopath Assoc. 2011 Sep. 111(9):543-7. [Medline].

  36. Kenny RA, Traynor GB, Withington D, Keegan DJ. Thoracic outlet syndrome: a useful exercise treatment option. Am J Surg. 1993 Feb. 165(2):282-4. [Medline].

  37. Lindgren KA. Conservative treatment of thoracic outlet syndrome: a 2-year follow-up. Arch Phys Med Rehabil. 1997 Apr. 78(4):373-8. [Medline].

  38. Novak CB, Collins ED, Mackinnon SE. Outcome following conservative management of thoracic outlet syndrome. J Hand Surg [Am]. 1995 Jul. 20(4):542-8. [Medline].

  39. Novak CB. Conservative management of thoracic outlet syndrome. Semin Thorac Cardiovasc Surg. 1996 Apr. 8(2):201-7. [Medline].

  40. Leffert RD. Complications of surgery for thoracic outlet syndrome. Hand Clin. 2004 Feb. 20(1):91-8. [Medline].

  41. Terzis JK, Kokkalis ZT. Supraclavicular approach for thoracic outlet syndrome. Hand (N Y). 2010 Sep. 5(3):326-37. [Medline]. [Full Text].

  42. Vemuri C, Wittenberg AM, Caputo FJ, Earley JA, Driskill MR, Rastogi R, et al. Early effectiveness of isolated pectoralis minor tenotomy in selected patients with neurogenic thoracic outlet syndrome. J Vasc Surg. 2013 Jan 31. [Medline].

  43. Balci AE, Balci TA, Cakir O, Eren S, Eren MN. Surgical treatment of thoracic outlet syndrome: effect and results of surgery. Ann Thorac Surg. 2003 Apr. 75(4):1091-6; discussion 1096. [Medline].

  44. Franklin GM, Fulton-Kehoe D, Bradley C, Smith-Weller T. Outcome of surgery for thoracic outlet syndrome in Washington state workers' compensation. Neurology. 2000 Mar 28. 54(6):1252-7. [Medline].

  45. Orlando MS, Likes KC, Mirza S, Cao Y, Cohen A, Lum YW, et al. A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome. J Am Coll Surg. 2015 May. 220 (5):934-9. [Medline].

  46. Foley JM, Finlayson H, Travlos A. A review of thoracic outlet syndrome and the possible role of botulinum toxin in the treatment of this syndrome. Toxins (Basel). 2012 Nov. 4(11):1223-35. [Medline].

  47. Povlsen B, Hansson T, Povlsen SD. Treatment for thoracic outlet syndrome. Cochrane Database Syst Rev. 2014 Nov 26. 11:CD007218. [Medline].

  48. Atasoy E. Recurrent thoracic outlet syndrome. Hand Clin. 2004 Feb. 20(1):99-105. [Medline].

  49. Arcasoy SM, Jett JR. Superior pulmonary sulcus tumors and Pancoast's syndrome. N Engl J Med. 1997 Nov 6. 337(19):1370-6. [Medline].

  50. Edwards DP, Mulkern E, Raja AN, Barker P. Trans-axillary first rib excision for thoracic outlet syndrome. J R Coll Surg Edinb. 1999 Dec. 44(6):362-5. [Medline].

  51. Green SM. Tarascon Pocket Pharmacopoeia. Loma Linda, Calif: Tarascon Press; 1999. 10-11, 30, 46.

  52. Terao T, Ide K, Taniguchi M, et al. [The management of patients with thoracic outlet syndrome (TOS) and an assistant diagnosis to discriminate between TOS and cervical spondylosis] [Japanese]. No Shinkei Geka. 2008 Jul. 36(7):615-23. [Medline].

  53. Weber RJ, Lebduskin S. Rehabilitation issues in plexopathies. Phys Med Rehabil. 1988. 996-8.

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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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