Conservative Treatment of Thoracic Outlet Syndrome

This study examined a group of 119 patients who had been diagnosed with thoracic outlet syndrome (TOS). At the beginning of the study, 50% of the patients were currently employed, 48% were on sick leave or retired, and 2% were unemployed. All 119 patients were instructed on how to perform daily stretching exercises; those exercises considered to be the most important were those that stretched the anterior, lateral, and posterior scalenes.

The patients were then re-evaluated an average of 24.6 months after the initial exercise training. At follow-up:

• 88.1% of the patients were satisfied with the outcome; 81.5% had a normal cervical range of motion; 64.9% of patients with a reduced grip strength at baseline now had normal grip strength; and 58.5% of those with a positive Tinel's sign now had a normal Tinel's.
• In terms of work, 62.6% returned to their former work; 10.4% required job re-training; and 26.1% retired. Those who retired, however, had health problems unrelated to the TOS symptoms.

The authors state that, "the results after surgery are no better than a placebo effect, a fact that is overlooked...According to the present study, conservative therapy is the treatment of choice in TOS because it is safe and can be implemented as a self-treatment program."

Lindren KA. Conservative treatment of thoracic outlet syndrome: a 2-year follow-up. Archives of Physical Medicine and Rehabilitation 1997;78:373-378.