Therapy | Thoracic outlet syndrome

Therapy

There are two possibilities for the therapy of Thoracic outlet syndrome. On the one hand there is the conservative, non-surgical variant and on the other hand there is the possibility of surgery. The conservative option consists of physiotherapeutic exercises of the affected area and the use of medication.

In bottleneck syndrome, painkillers from the group of non-steroidal anti-rheumatic drugs (NSAIDs) such as diclofenac or ibuprofen are used. They are intended to relieve the existing pain and at the same time have a positive effect on any inflammation that may be present. Muscle-relaxing drugs can also be used if one suspects that the bottleneck is caused by a possible overloading or tension of a muscle.

It is also possible that cold or heat applications can alleviate the symptoms. Typically, patients with Thoracic Outlet Syndrome are referred by their family doctor to a neurologist, orthopaedic surgeon or vascular surgeon. The vascular surgeon is the specialist who is the expert in Thoracic Outlet Syndrome at the latest when conservative treatment fails to provide advice and perform surgical therapy.

It is important that the affected person is prescribed early physiotherapeutic treatment. Mild symptoms of Thoracic Outlet Syndrome are usually first treated with physiotherapy. This treatment leads to an alleviation of the symptoms in about 60% of patients.

There are some exercises to strengthen the shoulders and neck muscles in Thoracic Outlet Syndrome.Basically, you should have individually suitable exercises shown to you by experienced physiotherapists and practice them first under observation of the physiotherapists. The patient stands and lets his arms hang down. He holds a weight in his hands (e.g. 1 kg, a water bottle is also possible).

The patient shrugs his armpits forward and upwards about 10 times and then lets the muscles relax. Then the patient shrugs backwards and upwards, about 10 times and then the muscles relax. Finally, he shrugs his armpits up and up for 10 moves and relaxes the muscles.

The patient stands upright and stretches the arms sideways at shoulder height. He holds a 1 kilogram weight in both hands and the palms of his hands are pointing downwards. The exercise consists of raising the arms sideways until the backs of the hands touch above the head, while the arms remain stretched out.

The exercise is also repeated ten times. The patient stands up straight with the arms sideways and bends the neck to the left side, trying to put the left ear against the left shoulder. The shoulder is not lifted.

The same is done on the right side and each side for ten attempts in total. The patient lies on his back with his arms to the side. Between the shoulder blades a rolled up blanket or pillow is placed, but no pillow under the head.

In this exercise, the patient takes a slow deep breath and raises the arms. Repeat the whole thing five to twenty times. Between all the exercises and whenever you feel like it, the muscles should be relaxed.

You can have as many breaks as you like during these exercises.

• The patient stands and lets his arms hang down. In doing so, he holds a weight in his hands (e.g. 1 KG heavy, a water bottle is also possible).

  The patient shrugs his armpits forward and up, about 10 times and then lets the muscles relax. Then the patient shrugs backwards and upwards, about 10 times and then the muscles relax. Finally, he shrugs his armpits up and up for 10 moves and relaxes the muscles.

• The patient stands upright and stretches the arms sideways at shoulder height.

  He holds a weight of 1 kilogram in both hands and the palms of his hands point down. The exercise consists of raising the arms sideways until the backs of the hands touch above the head, while the arms remain stretched out. The exercise is also repeated ten times.

• The patient stands up straight with his arms sideways and bends the neck to the left side, trying to put the left ear against the left shoulder.

  The shoulder is not lifted. The same is done on the right side and each side for ten attempts in total.

• The patient lies on his back with his arms to the side. A rolled up blanket or pillow is placed between the shoulder blades, but no pillow under the head.

  In this exercise the patient takes a slow deep breath and raises his arms. Repeat the whole thing five to twenty times.

Surgery is indicated for Thoracic Outlet Syndrome when conservative treatment methods fail. This means that surgery is required when pure physiotherapy is no longer sufficient to effectively relieve the symptoms.

Then the constricting structure is surgically removed, often cervical rib and first rib. Occasionally, the minor pectoralis muscle is surgically severed to end the constriction. In particular, persistent pain, severe night-time pain, as well as changes in the subclavian artery or vascular occlusions require surgical therapy. In addition, nerve damage should also be treated surgically to repair it. Rehabilitation is usually not necessary after surgery for thoracic outlet syndrome.