Conservative Treatment of Neurogenic Thoracic Outlet Syndrome

Conservative treatment of neurogenic thoracic outlet syndrome remains the primary treatment modality

Conservative treatment remains the primary approach in almost all patients with neurogenic thoracic outlet syndrome. Treatment of neurogenic thoracic outlet syndrome rarely, if ever, represents a surgical emergency. Therefore, treatment planning and trials can be much more deliberate and staged. Progress can be judged over these trials, and surgery may be avoided in many patients with neurogenic TOS. Conservative treatment of neurogenic thoracic outlet syndrome modalities may be performed sequentially or in conjunction with one another. Although the medical literature does not prove superiority of one form of conservative therapy over another, authorities widely accept conservative treatment of neurogenic thoracic outlet syndrome as the first step in treatment of neurogenic thoracic outlet syndrome.

Physical Therapy

Physical therapy remains one of the mainstays of conservative treatment of patients with neurogenic TOS. Physical therapy aims to reduce pain and improve function. Physical therapists help their patients recover from sports injuries, trauma, or strokes, improve flexibility or movement, and learn to use a cane or function with a splint.

Physical therapists must undergo specific training, including a masters degree or a doctorate. They also must pass a qualifying examination, and are licensed in every state. It is important to remember that just like physicians, physical therapists often specialize within their field. Thus, a patient should strive to work with a physical therapist who is knowledgeable about and experience in the treatment of neurogenic TOS.

Physical therapists who treat patients with neurogenic TOS may use one or more of the following techniques:

• Massage therapy
• Postural correction
• Breathing control and retraining
• Electrical stimulation
• Stretching
• Superficial heat or deep heat therapy (ultrasound may be used)
• Myofascial release, including mobilization and manipulation
• Education

The ENVEST (Edgelow Neurovascular Entrapment Syndrome Treatment) technique was developed by a widely-recognized physical therapist, Peter Edgelow. The ENVEST technique is widely known as a specialized and effective technique for treatment of neurogenic TOS patients. Dr. Edgelow taught his technique to many hundreds of physical therapists, and it is worth finding a therapist who is familiar and experienced with this technique. You can read more the ENVEST technique here.

Chiropractic

Chiropractic focuses on the relationship between the structure and function of the body. Primarily, chiropractors manipulate the spine to achieve balance, with the intention of maintaining or restoring balance and normal function. However, chiropractors often add a number of other therapies to spinal manipulation. For example, many chiropractors offer electrical stimulation, relaxation techniques, laser therapy, and counseling on diet, exercise and health.

Many patients with neurogenic TOS utilize chiropractic as a central and critical component of their treatment program. Chiropractors contribute significant hands-on therapy and time with patients. Patients often form a productive therapeutic alliance with their chiropractor, among other team members.

Drugs

Appropriate use of drugs plays a key role in the conservative treatment of patients with neurogenic TOS. Several classes of drugs may be used:

Pain drugs-Direct treatment with pain medication is almost always a part of the regimen. Pain medications may include NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, or stronger opiates such as fentanyl in severe flares. In general, opiate pain medications have significant risks, including addiction, and are only used in a short-term plan or flare.

Nerve-stabilizing drugs-These drugs were originally developed to treat depression or seizures. However, they have been found to help desensitize irritated nerves and to reduce the pain signals created by these nerves. Examples include anti-depressants, such as Elavil, and anti-seizure drugs such as Lyrica, Cymbalta, and Neurontin.

Evidence has also recently been published regarding the use of medical marijuana in chronic pain patients. Marijuana has been shown to work effectively with opiates, decreasing the dose of opiates required while lowering pain to a greater extent than opiates alone.

Occupational Therapy

Occupational therapists help patients perform activities regardless of disability or injury. Stated another way, occupational therapists do not aim to cure or treat patients. Instead, they evaluate the patient’s current condition and provide the means by which the patient can perform their normal occupations. Occupations in this case are defined as the every day activities of the patient.