Treatment of Thoracic Outlet Syndrome
Treatment of Thoracic Outlet Syndrome
Successful treatment of thoracic outlet syndrome depends on the timely and accurate diagnosis of thoracic outlet syndrome. Thoracic outlet syndrome specialists must have accurate knowledge of all involved structures to plan successful treatment.
Different Treatment for Each Type of Thoracic Outlet Syndrome
Doctors view each type of thoracic outlet syndrome differently, in terms of urgency and optimum treatment modality. In general, the following choices become pertinent when making decisions about the treatment of thoracic outlet syndrome:
Anatomy of the thoracic outlet
Introduction to the treatment of thoracic outlet syndrome
Treatment of Neurogenic Thoracic Outlet Syndrome
Treatment of neurogenic thoracic outlet syndrome challenges many thoracic outlet syndrome specialists. By and large, these specialists understand that there is tremendous complexity of the brachial plexus and the anatomy of the thoracic outlet. For this reason, patients have complex symptoms. Thus, treatment decisions are equally complex.
Generally speaking, treatment decisions do not require urgency. Thoracic outlet syndrome specialists have time to perform a full and complex evaluation of these patients, including advanced imaging studies.
To begin with, patients and TOS specialists face the primary decision of whether to undergo conservative treatment or surgical treatment. Conservative treatment of neurogenic thoracic outlet syndrome may include physical therapy, occupational therapy, specialized injections, anti-inflammatory medications, and nerve-stabilizing drugs, among others. Surgical treatment of neurogenic thoracic outlet syndrome presents a number of options, depending on the surgeon and institution.
Treatment of Venous Thoracic Outlet Syndrome
Treatment of venous thoracic outlet syndrome has evolved significantly, although debate continues regarding optimal treatment methods and timing. Nonetheless, if a doctor diagnoses and treats venous TOS promptly, treatment outcomes are usually excellent.
To begin with, doctors treat nearly all patients immediately by dissolving the blood clot in the subclavian vein. After the dissolution of blood clot, physicians have a choice to pursue conservative treatment or surgical management. However, it is now clear that surgical treatment provides significantly better results than conservative treatment.
Surgical treatment involves 4 components:
- Dissolving the blood clot
- Removing the structures that are compressing the vein
- Repairing the vein
- Performing venography to assess results
Surgeons use several modern treatment tools, and choose from several surgical options in patients with venous TOS.
Treatment of Arterial Thoracic Outlet Syndrome
For the most part, arterial thoracic outlet syndrome presents with an acute onset of arterial blockage, or acute arterial occlusion. Specifically, a blood clot has formed within a damaged artery, broken off, traveled to a smaller artery, and blocked it. As a result, the patient has a high risk for severe complications. Therefore, doctors almost always treat the arterial blood clot immediately. Once doctors successfully treat the blood clot, they perform imaging studies of the artery and the thoracic outlet. Further definitive treatment depends on the presence and underlying cause of damage to the artery. In general, doctors repair the damaged arterial segment, after which they remove any external structures compressing the artery.
What are the key elements to remember about treatment of thoracic outlet syndrome?
Firstly, almost all patients with venous thoracic outlet syndrome or arterial thoracic outlet syndrome require urgent surgical treatment. Your thoracic outlet syndrome specialist should recognize these conditions immediately, and begin treatment of the venous or arterial blood clot.
Second, treatment of neurogenic thoracic outlet syndrome is much less urgent. Initial treatment is almost never immediate and surgical.
Third, many treatment options are available for patients with neurogenic thoracic outlet syndrome. The first decision for a patient and their specialist is whether to pursue conservative treatment or surgical treatment.
Fourth, once a conservative or surgical treatment plan is selected, many choices exist for either treatment pathway. Experienced thoracic outlet syndrome specialist surgeons offer new promising surgical approaches throughout the country. The decision to go to surgery should be well-researched, and all options considered before taking a permanent step.
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