Conservative treatment of Thoracic Outlet Syndrome – A Review of the Literature

ABSTRACT CONTEXT: Thoracic Outlet Syndrome (TOS) is a debated topic. While there are many clinical studies concerning the efficacy of surgical treatment, there are few regarding conservative treatment. Whether or not conservative treatment is effective and which the best treatment is has not been established yet. AIMS: (a) To evaluate the efficacy of conservative treatment in TOS with particular reference to physiotherapy, orthotics, and taping; (b) to make general recommendations for conservative treatment. METHODS: The literature was reviewed. Medical databases consulted: Medline, Embase, CINAHL, Current Awareness, Pedro, Cochrane Library, Medscape. We used the following key words: Thoracic Outlet Syndrome, Double Crush Syndrome, Entrapment, Conservative, Treatment, Rehabilitation, Management. Languages of the articles reviewed: English, French, German, Spanish, Italian, Portuguese. RESULTS: This analysis focussed on ten studies of conservative treatment and three studies comparing the outcomes of conservative and surgical treatment, published from 1983 to 2001. This review found no randomised controlled trials, systematic reviews, or meta-analyses. CONCLUSIONS: Conservative treatment seems to be effective in reducing symptoms, improving function, and facilitating return to work, also when compared to surgery. Whether or not conservative treatment is better than no treatment or placebo could not be established, nor could which particular conservative treatment is the best.