Treatment for thoracic outlet syndrome

Area of Science:

• Neurology
• Vascular Surgery
• Orthopedic Surgery

Background:

• Thoracic outlet syndrome (TOS) is a clinically controversial condition.
• Evidence-based management is lacking despite numerous reported interventions.

Purpose of the Study:

• To evaluate the efficacy and safety of operative and non-operative treatments for TOS.
• To synthesize available scientific evidence for TOS interventions.

Main Methods:

• Systematic search of multiple databases (Cochrane, MEDLINE, EMBASE, CINAHL, AMED) up to June 2009.
• Inclusion of randomized or quasi-randomized studies for all TOS types (neurogenic, vascular, disputed).
• Primary outcome: pain reduction (visual analog scale) at six months; secondary outcomes: muscle strength and adverse effects.

Main Results:

• The review faced challenges due to a lack of standardized TOS diagnostic criteria.
• One high-risk-of-bias study (55 participants) indicated transaxillary first rib resection was superior to supraclavicular neuroplasty for pain reduction.
• No adverse effects were reported in the included trial; no studies compared interventions to natural progression.

Conclusions:

• A significant lack of high-quality evidence exists for TOS treatments due to diagnostic and methodological limitations.
• Very low-quality evidence suggests a potential benefit of transaxillary first rib resection over supraclavicular neuroplasty.
• There is an urgent need for agreed-upon diagnostic criteria, outcome measures, and high-quality randomized trials comparing interventions to each other and to no treatment.