Video 1: All about thoracic outlet syndrome (TOS): Diagnosis
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What are the types of thoracic outlet syndrome (TOS)?
Sam Farres, M.D., Chair, Division of Vascular Surgery Mayo Clinic in Florida: Very broadly speaking, it can be divided into neurogenic thoracic outlet, if the nerves are compressed or irritated. The other type is vascular thoracic outlet, if the artery or the veins are compressed. And I would like to add a third type where both nerve and vessels are compressed, and that can be called non-specific TOS.
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Can I get thoracic outlet syndrome (TOS) on both sides?
Dr. Farres: Yes, that can happen. It's less common, but it can happen on right side, left side, dominant arm or the non-dominant one. Or some kind of combination. So that potentially can occur.
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How is thoracic outlet syndrome (TOS) diagnosed?
Dr. Farres: It's important to have a correct diagnosis for a thoracic outlet as this will determine what type of therapy and treatment is implemented. It's typically an exclusion of diagnosis, and this process starts with physical examination and good history, followed by imaging studies, vascular studies, provocative tests, and consultation with a multidisciplinary team in order to exclude what's usually more common.
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Who treats thoracic outlet syndrome (TOS)?
Dr. Farres: So thoracic outlet syndrome can be assessed and managed by multiple health professionals. At Mayo Clinic, Florida, we have a multidisciplinary team that typically assesses, diagnoses, and then manages thoracic outlet. So, in addition to vascular surgery as a team, we also have a peripheral neurologist who would assess the patient. Physical medicine and rehabilitation, peripheral neurologist, brachial plexus specialist, pain medicine, intervention radiology and regional anesthesia will help in the assessment and diagnosis of thoracic outlet and then the treatment.
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Video 2: All about thoracic outlet syndrome (TOS): Treatment
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Can I treat thoracic outlet syndrome (TOS) with physical therapy and sports medicine?
Sam Farres, M.D., Chair, Division of Vascular Surgery Mayo Clinic in Florida: Absolutely. In fact, physical therapy and sports medicine can be used effectively in treating particularly neurogenic thoracic outlet syndrome. Usually it focuses on improving posture and posture correction, in addition to strengthening and stretching exercises. Sports medicine can effectively offer guidance toward activity modification and pain management. And a tailored program and exercise for an individual patient can help in improving symptoms and avoiding invasive treatment.
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What are the treatment options for thoracic outlet syndrome (TOS)?
Dr. Farres: Treatment options for TOS varies based on the underlying cause and the type of the TOS – neurogenic, vascular or non-specific. It's crucial to customize the treatment based on the underlying cause and to have it tailored through a multidisciplinary approach. Having said that, the most common treatment options are medications such as muscle relaxant, lifestyle modification, ergonomic movement, posture corrections. And more invasive would be injections and surgery as the form of the most invasive type of treatment.
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What are the pros and cons of getting an injection for thoracic outlet syndrome (TOS)?
Dr. Farres: The treatment for TOS varies based on the type of TOS, the severity of symptoms, and the underlying cause. But, broadly speaking, the pros for injections would be the fact that they are less invasive, they associate with less risk compared with surgery. They provide temporary relief of symptoms and sometimes can be used as diagnostic tools to know if the condition we are dealing with is thoracic outlet syndrome. On the other hand, the injection treatment will not last for a long time, since it's temporary in relieving the symptoms, and will not remove the underlying cause and has limited durability.
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What are the pros and cons of getting surgery for thoracic outlet syndrome (TOS)?
Dr. Farres: Surgery can provide definitive treatment, long term result and can be tailored to the specific underlying cause in addressing the structural abnormalities. On the other hand, surgery is more invasive, has longer recovery time and associate potentially with surgical related complications.
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What is the best surgical approach for thoracic outlet syndrome (TOS)?
Dr. Farres: The best surgical approach depends on the type of the TOS we're dealing with in addition to the underlying cause in patient symptoms and presentation. In fact, it can be tailored according to that and based on the multidisciplinary team recommendations.
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