Treatment of neurogenic TOS remains challenging
The primary focus of treatment in patients with neurogenic TOS is to relieve compression or stretching of the brachial plexus. Many doctors begin with conservative therapy, including physical therapy, occupational therapy, massage or acupuncture. A minority of patients with neurogenic TOS will eventually require surgery. Surgical results are variable, but depending on the surgeon and the selected technique the results may be quite good.
No matter the modality, treatment of neurogenic TOS remains quite challenging. It is important to understand that no single treatment modality has been proven superior in all patients. Understand that there are a large number of underlying mechanisms that cause neurogenic TOS. Thus, it would be unrealistic to expect one treatment to work in all patients. It is wise to remain cautious of any provider who uses the same approach in all patients.
Many patients experience improvement with a progressive or multi-modality treatment plan. A progressive treatment plan would include one type of conservative therapy, gradually increasing in intensity, or a sequence of different conservative modalities. A multi-modality plan would combine various conservative treatment modalities at one time, which may change over time. In either of these patient groups, surgery would remain a treatment option if conservative treatment fails.
Neurogenic TOS rarely presents as a surgical emergency. However, a minority of patients with neurogenic TOS eventually require surgical treatment. Therefore, it is useful to include an early surgical consult in most treatment plans. This allows the surgeon to observe the progress or lack of progress in a patient.
For these reasons, TOS specialists and patients should consider all forms of treatment. The patient and doctor should work together to build a successful treatment program, with frequent review of progress and consideration of all options.
Treatment of neurogenic TOS is often controversial
Optimal treatment of patients with neurogenic TOS remains the subject of active and lively discussion among TOS specialists. Providers and patients can choose from a broad array of treatment options. Many of these options are not well-proven or objectively compared with other treatment options. Many TOS specialists strongly prefer one option, often to the exclusion of others. These specialists may have little or no experience with other treatment modalities. For these reasons, patients often find it difficult to gather useful information about their treatment choices. They may have to take their doctor’s advice on faith, often without awareness or detailed knowledge of other options.
Our goal is to provide the reader with a broad outline of treatment options first, followed by more detailed discussions of each modality. We will also consider alternative treatment modalities that hold promise for improving outcomes.
To begin with, treatment choices for patients with neurogenic TOS can be divided into two broad groups: