Thoracic Outlet Syndrome in Emergency Medicine Follow-up

Updated: Aug 09, 2017
  • Author: Andrew K Chang, MD, MS; Chief Editor: Erik D Schraga, MD  more...
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Further Outpatient Care

A Cochrane review concluded that despite many reports on conservative and surgical intervention, complications, outcomes, and success rates, rigorous scientific investigation and management is lacking. [10]

For most patients, conservative treatment is generally recommended. Stress avoidance, work simplification, and job site modification are also recommended to avoid sustained contraction and repetitive or overhead work that exacerbate symptoms.

Myofascial or chronic pain elements can be addressed through exercise programs, good posture, and self-management.

The potential outlet space can be maximized through a program of stretching and strengthening of the shoulder-elevating mechanism, such as with the following:

  • Trapezius and rhomboid strengthening (eg, shoulder shrugs and bilateral shoulder retraction while standing or lying prone)
  • Shoulder mobilization (eg, hand circles and standing corner pushups)
  • Postural exercises (eg, cervical and lumbar spine extension)

Inpatient & Outpatient Medications

Anticoagulate with Coumadin for a minimum of 3 months for vascular TOS.

Analgesics are seldom helpful except to assist in the institution of a progressive exercise program.

A short-monitored course with tricyclic antidepressants may be helpful if the time course and symptoms suggest a protracted pain syndrome.