Thoracic Outlet Syndrome Follow-up

Updated: Jan 10, 2019
  • Author: Daryl A Rosenbaum, MD; Chief Editor: Sherwin SW Ho, MD  more...
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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.

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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. [53] 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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