Conservative treatment of thoracic outlet syndrome: a 2-year follow-up.

OBJECTIVE: To evaluate a conservative therapy program that aims to restore normal function to the upper thoracic aperture in patients with thoracic outlet syndrome (TOS).

DESIGN: A descriptive study of consecutive patients with a positive TOS index seen from 1988 to 1993. After therapy, the patients were followed for a mean period of 24.6 months.

SETTING: Therapy was initiated primarily in an inpatient rehabilitation ward over an 11.4-day (range 4-24 days) stay.

PATIENTS: One hundred nineteen patients (28 men and 91 women) with a positive TOS index participated. At admission, 50% of the patients were employed, 48% were on sick leave or retired, and 2% were unemployed.

INTERVENTIONS: The patients received instructions on how to restore the normal function of their cervical spine and upper thoracic aperture by means of home exercises.

MAIN OUTCOME MEASURES: The efficacy of the treatment program was assessed by the frequency of return to work, normalization of the motion of the cervical spine and upper thoracic aperture, and subjective satisfaction with the outcome.

RESULTS: At the follow-up examination, 88% of the patients were satisfied with the outcome of their treatment, and the ranges of motion of the cervical spine and upper thoracic aperture had normalized in 8 of 10 patients. Seventy-three percent of the patients returned to work after the therapy, either directly or after retraining, and 88% of the patients carried through the recommendations given at discharge during long-term follow-up. Normalized grip strength and Tinel's sign predicted patient satisfaction (p < .001) and return to work (p < .001). Return to work was more often successful if the work was sedentary rather than heavy (p < .05).

CONCLUSIONS: The treatment program provides relief to most patients with symptoms of TOS. If the symptoms are not relieved, the differential diagnosis should be reviewed. Conservative therapy with the aim of restoring the function of the upper thoracic aperture is to be recommended, and long-term follow-up is advisable.