Physical Medicine and Rehabilitation for Thoracic Outlet Syndrome Follow-up

Updated: May 15, 2017
  • Author: Benjamin M Sucher, DO, FAOCPMR, FAAPMR; Chief Editor: Dean H Hommer, MD  more...
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Follow-up

Further Outpatient Care

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  • Outpatient care for thoracic outlet syndrome includes physical therapy, manipulation, and occupational therapy. See the Treatment section.
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Further Inpatient Care

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  • No inpatient care is indicated for thoracic outlet syndrome, unless the patient is treated surgically.
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Deterrence

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  • In some cases, thoracic outlet syndrome (TOS) may be preventable. Proper flexibility and strength, along with good posture, are very important for individuals who are at risk for developing this condition. One should avoid stressful positions and limit the amount of time completing repetitive or overhead activities. A workstation evaluation may be very beneficial to identify potential causes of TOS. If repetitive or overhead activities are required at work, one should take frequent rest breaks, change positions whenever possible, and ensure a proper workstation setup. Avoidance of working with outstretched arms and heavy lifting or carrying also can help to avoid developing TOS symptoms.
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Complications

Complications that may develop in individuals with thoracic outlet syndrome include the following:

  • Chronic pain
  • Disability and loss of functional ability with the upper extremity
  • Depression
  • Neurologic deficit
  • Thrombosis
  • Ischemia
  • Pseudoaneurysm
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Prognosis

Prognosis is generally good for most cases of thoracic outlet syndrome (TOS), unless it is severe and requires surgery. Some patients may develop chronic pain and disability that can be complicated by legal and psychological issues. Recognition and prompt treatment of such psychological and disability issues can limit the complications.

Most patients obtain relief of paresthesias and numbness with a return of strength or activity tolerance; however, recurrence is common, especially with resumption of the activity that led to symptom onset. Posture correction and strengthening usually is necessary to maintain improvement.

In a study by Likes et al of patients with TOS, 100 out of 271 patients (37%) who were initially managed with TOS-specific physical therapy improved with this treatment alone. [17]

In a study of competitive athletes with TOS, however, only mild to modest symptom improvement was seen in those with neurogenic TOS who were initially treated with TOS-specific physical therapy. Consequently, 67% of the neurogenic TOS patients went on to be treated with supraclavicular first rib resection and brachial plexus neurolysis. Nonetheless, of the 81% of the group with neurogenic TOS who were able to return to full competitive athletics, 32% did so after management only with physical therapy. [18]

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Patient Education

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  • Educating patients about the causes or perpetuating factors involved in thoracic outlet syndrome is essential. Offer training to minimize the likelihood of recurrence.
  • Proper use of keyboards and adjustment of workstation ergonomics are useful. Specific techniques for exercise and motivation are necessary. Appropriate management of stress and depression also are helpful.
  • For excellent patient education resources, see eMedicineHealth's patient education article Shoulder and Neck Pain.
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