Treatment for thoracic outlet syndrome

Area of Science:

• Medical research
• Clinical medicine
• Systematic reviews

Background:

• Thoracic outlet syndrome (TOS) is a controversial diagnosis with a lack of evidence-based management.
• This review is the first update since 2010, addressing the need for scientific investigation.

Purpose of the Study:

• To evaluate the effectiveness and safety of interventions for TOS.
• Assess outcomes at least six months post-intervention.

Main Methods:

• Searched multiple databases for randomized or quasi-randomized studies on TOS interventions.
• Included studies with any TOS type and any intervention, focusing on pain reduction, muscle strength, disability, paresthesias, and adverse effects.

Main Results:

• A lack of diagnostic criteria complicated the review.
• One study showed transaxillary first rib resection (TFRR) reduced pain more than supraclavicular neuroplasty (SNBP) but had a high risk of bias.
• Botulinum toxin (BTX) injections showed no significant pain relief or disability improvement over placebo but improved paresthesias.

Conclusions:

• Very low-quality evidence suggests TFRR may be better than SNBP for pain, but no randomized evidence supports either over no treatment.
• Moderate evidence indicates BTX injections offer no significant advantage over placebo.
• High-quality trials with agreed diagnostic criteria and outcome measures are needed for TOS treatments.