How can I prevent thoracic outlet syndrome?
The anatomy of the thoracic outlet is bordered by the clavicle and the first rib, between which the subclavian artery and vein pass. The scalene triangle between the anterior and middle scalene muscles is where the brachial plexus passes, innervating the upper extremity. Congenital anomalies such as cervical ribs and muscular anomalies cannot be prevented, but Thoracic Outlet Syndrome (TOS) progression can.
Treatment is indicated only for those with signs and symptoms; prevention of signs and symptoms is by eliminating the risk of compression due to injuries or physical activities responsible for neurovascular compression. Prevention and treatment often are dictated by the specific structure compressed, i.e., subclavian artery, subclavian vein, or brachial nerve plexus.
Prevention of symptomatic TOS
- Physical therapy to decrease tension from the scalene musculature, encourage proper posture, and avoid undue scalene muscular hypertrophy
- Injections of anesthetics, steroids, or Botox into the thoracic outlet, scalene triangle, or scalene muscles
- In subclavian vein compression, anticoagulation or thrombolytic therapy to prevent or dissolve venous thrombus formation. In arterial ischemia due to an arterial thrombus or embolus, catheter-directed thrombolysis or embolectomy is indicated
- Surgery to remove cervical or other anomalous ribs, correct distortion of clavicular anatomy from injury, or to release tension from the scalene musculature