Thoracic Outlet Syndrome Treatments

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Contact the Thoracic Outlet Syndrome Program

1-617-355-9600
International: 1-617-355-5209

Treatment Goals:
Regardless of the type, our goal in the treatment of thoracic outlet syndrome is to return the patient to full function. This requires varying levels of intervention as dictated by the patient’s particular circumstances, and ranges from physical therapy to interventional radiologic techniques to surgery, often in combination.


The surgery was tough, and the recovery was hard but going through everything I did made me a better person. The dedication and passion the doctors and therapists show towards their patients and the care they take toward their family make all of the difference... It may feel like the worst option at the moment but it will be the best choice you will ever make and every second of getting better is worth the price.

Joey Peduto


Physical Therapy:
Treatment of the thoracic outlet syndrome can usually be successful with conservative measures. Treatments include a variety of exercises that effectively stretch open the tissues of the thoracic outlet. These are done with and without weights in the hands to pull the outlet into a "relaxed" open position. Physical therapists are specially trained in the instruction of exercises for thoracic outlet syndrome, and their evaluation of the patient can be helpful. Shoulder-shrug exercises and others can be done at home or at work to relax the muscles around the thoracic outlet. Treatment of nTOS can usually be successful with conservative measures. Treatments include a variety of exercises that effectively stretch open the tissues of the thoracic outlet. These are done with and without weights in the hands to pull the outlet into a "relaxed" open position. Physical therapists are specially trained in the instruction of exercises for thoracic outlet syndrome, and their evaluation of the patient can be helpful. Shoulder-shrug exercises and others can be done at home, school or work to relax the muscles around the thoracic outlet.

Patients should avoid prolonged positions with their arms held out or overhead. For example, it is best to avoid sleeping with the arm extended up behind the head. It is also helpful to have rest periods at work to minimize fatigue. Weight reduction can be helpful for obese patients. Patients should avoid sleeping on their stomach with their arms above the head. They should also not repetitively lift heavy objects.

Physical therapy may be done before surgery, as in the case of neurogenic TOS, or may be utilized following surgery to assist in recovery of stability and strength.

Medications:
A health-care professional might prescribe medications such as an anti-inflammatory medications (ibuprofen [Advil]) or muscle relaxants to help improve the symptoms.  Cortisone injected into a joint or muscle can help lower inflammation and provide relief.  For patients with venous or arterial TOS, blood thinners may be prescribed to prevent or treat blood clots.

Surgery:
Some patients with severe, resistant symptoms in nTOS or with venous or arterial TOS can require surgical operations to open the thoracic outlet. These procedures include removal of the anterior scalene muscle (scalenectomy) and removal of the first rib in order to spare injury to the affected nerve and blood vessels from ongoing compression. Thoracic outlet syndrome that affects the vascular system (veins and arteries) is more likely to require surgery to resolve the symptoms.
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- Sandra L. Fenwick, President and CEO

Boston Children's Hospital
300 Longwood Avenue, Boston, MA 02115
For Patients: 617-355-6000 | 800-355-7944

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