Treatment of Thoracic Outlet Syndrome

Treatment of Thoracic Outlet Syndrome

Successful treatment of TOS depends on timely and accurate diagnosis.  Doctors must have accurate knowledge of all involved structures to plan successful treatment.

Successful treatment of TOS depends on timely and accurate diagnosis.  Doctors must have accurate knowledge of all involved structures to plan successful treatment.

Treatment of TOS

Treatment of TOS varies with each type of TOS

Doctors view each type of TOS differently, in terms of urgency and optimum treatment modality. In general, the following choices become pertinent when making decisions about the treatment of TOS:

  • Urgency of treatment
  • Modality of treatment-surgical vs. conservative
  • Treatment of the compressed vital structure vs. treatment of the surrounding structures
  • Treatment of affected areas outside the thoracic outlet
Treatment of TOS-Brachial Plexus, Subclavian Artery, Subclavian Vein

Anatomy of the thoracic outlet

Introduction to the treatment of TOS

Treatment of TOS-Neurogenic TOS

Treatment of neurogenic TOS is complex. By and large, doctors understand there is tremendous complexity of the brachial plexus and the anatomy of the thoracic outlet. For this reason, patients have complex symptoms. Thus, treatment decisions are equally complex.

Generally speaking, treatment decisions are not urgent. Doctors have time to perform a more complex evaluation of these patients, including advanced imaging studies. 

To begin with, doctors and patients face a primary decision whether to undergo conservative treatment or surgical treatment. Conservative treatment includes physical therapy, occupational therapy, specialized injections, anti-inflammatory medications, and nerve-stabilizing drugs, among others. Surgical treatment includes a number of options, depending on the surgeon and institution.

Treatment of TOS-Venous TOS

Treatment of venous TOS has evolved significantly, although debate continues regarding optimal treatment methods and timing. Nonetheless, if a doctor diagnoses and treats venous TOS promptly, treatment outcomes are usually excellent.

To begin with, doctors treat nearly all patients immediately by dissolving the blood clot in the subclavian vein. After the dissolution of blood clot, physicians have a choice to pursue conservative treatment or surgical management. However, it is now clear that surgical treatment provides significantly better results than conservative treatment.

Surgical treatment involves 4 components:

  • Dissolving the blood clot
  • Removing the structures that are compressing the vein
  • Repairing the vein
  • Performing venography to assess results

Surgeons use several modern treatment tools, and choose from several surgical options in patients with venous TOS.

Treatment of TOS-Arterial TOS

For the most part, arterial TOS presents with an acute onset of arterial blockage, or acute arterial occlusion. Specifically, a blood clot has formed within a damaged artery, broken off, traveled to a smaller artery, and blocked it.  As a result, the patient has a high risk for severe complications. Therefore, doctors almost always treat the arterial blood clot immediately. Once doctors successfully treat the blood clot, they perform imaging studies of the artery and the thoracic outlet. Further definitive treatment depends on the presence and underlying cause of damage to the artery. In general, doctors repair the damaged arterial segment, after which they remove any external structures compressing the artery.

Treatment of TOS

Urgent treatment for arterial and venous TOS

Treatment of neurogenic TOS is complex and challenging

How can I know I am moving forward with the right treatment?

Firstly, almost all patients with venous TOS or arterial TOS require urgent surgical treatment. Your doctor should recognize these conditions immediately, and begin treatment of the venous or arterial blood clot.

Second, treatment of neurogenic TOS is much less urgent. Initial treatment is almost never immediate and surgical.

Third, there are more treatment options for patients with neurogenic TOS. The first decision is whether to pursue conservative treatment or surgical treatment.

Fourth, there are many options for conservative treatment. It is important to realize that there are many options for surgical treatment, as well. There are experienced TOS specialist surgeons who offer new surgical approaches throughout the country. The decision to go to surgery should be well-researched, and all options considered before taking a permanent step.

Please read our detail pages for more information about each type of treatment.