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Treatments and drugs
By Mayo Clinic staffIn most cases, a conservative approach to treatment is effective, especially when the condition is diagnosed early. Conservative treatment for thoracic outlet syndrome may include:
- Physical therapy. You'll learn how to do exercises that strengthen your shoulder muscles to open the thoracic outlet, improve your range of motion and improve your posture. These exercises, done over time, will take the pressure off your blood vessels and nerves in the thoracic outlet.
- Relaxation. Techniques that help you relax, such as deep breathing, can keep you from tensing your shoulders and remind you to maintain good posture.
- Medications. Your doctor may prescribe pain medications, muscle relaxants and anti-inflammatory drugs — aspirin or ibuprofen (Advil, Motrin, others) — to decrease inflammation and encourage muscle relaxation.
If conservative treatments don't improve your symptoms or if you're experiencing signs of significant nerve damage, worsening muscle weakness or incapacitating pain, your doctor may recommend surgery. Your doctor may also recommend surgery if you've been diagnosed with true neurogenic thoracic outlet syndrome, in which case surgery is often the only treatment option.
Surgical options
Surgical treatment is usually effective in relieving the pain associated with thoracic outlet syndrome, but is often not as successful in treating muscle weakness, especially if the condition has gone untreated for an extended period of time.
A specialist in thoracic surgery or vascular surgery will perform the procedure. All surgical options to treat thoracic outlet syndrome pose a significant risk of injury to the brachial plexus. The most common surgical approaches for thoracic outlet syndrome treatment are:
- Anterior supraclavicular approach. This approach repairs compressed blood vessels. Your surgeon makes an incision just under your neck to expose your brachial plexus region. He or she then is able to look for signs of trauma or may discover fibrous bands contributing to compression near your first (uppermost) rib and can repair any compressed blood vessels.
- Transaxillary approach. In this surgery, your surgeon makes an incision in your chest to access the first rib, then removes a portion of the first rib to relieve compression. The advantage of this type of surgery is that it gives the surgeon easy access to the first rib without disturbing the nerves or blood vessels. But it also means the surgeon has limited access to the area's nerves and vessels, and most fibrous bands and cervical ribs that may be contributing to compression are hidden behind these nerves and blood vessels.
- Sheon RP. Overview of the nerve entrapment syndromes. http://www.uptodate.com/home/index.html. Accessed Sept. 9, 2008.
- NINDS thoracic outlet syndrome information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/thoracic/thoracic.htm. Accessed Sept. 9, 2008.
- Thoracic outlet syndrome. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00336. Accessed Sept. 9, 2008.
- Thoracic outlet syndrome general information. National Pain Association. http://www.nationalpainfoundation.org/MyPain/contentdirectory_ThoracicOutletSyndrome.asp. Accessed Sept. 9, 2008.
- Thoracic outlet syndromes. Merck Manuals Online Medical Library. http://www.merck.com/mmhe/sec06/ch095/ch095e.html. Accessed Sept. 9, 2008.
- Thoracic outlet syndrome. Society for Vascular Surgery. http://www.vascularweb.org/patients/NorthPoint/Thoracic_Outlet_Syndrome.html. Accessed Sept. 9, 2008.
