Our Summary

This study looked at the effectiveness of physical therapy and surgery in treating patients with neurogenic thoracic outlet syndrome (NTOS), a condition that causes pain and numbness in your shoulder and neck. Out of 150 patients, 40 found satisfactory improvement through physical therapy alone, while 90 needed surgery. The researchers found that both treatments were helpful, but surgery was more effective for those who didn’t see enough improvement from physical therapy. The researchers also noted that about 90% of those who had surgery saw a significant reduction in their symptoms. The study suggests that surgery can be a viable option when physical therapy doesn’t work, even for those with severe symptoms. However, they found it difficult to predict who would benefit most from physical therapy alone or surgery.

FAQs

  1. What is neurogenic thoracic outlet syndrome (NTOS)?
  2. What was the overall effectiveness of surgery and physical therapy in treating NTOS according to the study?
  3. Can surgery be considered as an option for individuals when physical therapy for NTOS does not yield satisfactory results?

Doctor’s Tip

One helpful tip a doctor might tell a patient considering thoracic outlet syndrome surgery is to carefully follow the post-operative instructions provided by the surgeon. This may include guidelines for physical therapy, pain management, and restrictions on certain activities to ensure a successful recovery. It is important to communicate any concerns or changes in symptoms to your healthcare provider to monitor progress and address any potential complications. Additionally, maintaining a healthy lifestyle, including regular exercise and proper posture, can help prevent future issues with thoracic outlet syndrome.

Suitable For

Patients with neurogenic thoracic outlet syndrome (NTOS) who do not see sufficient improvement from physical therapy alone are typically recommended thoracic outlet syndrome surgery. Surgery may also be recommended for patients with severe symptoms or those who experience persistent pain and numbness in the shoulder and neck despite conservative treatments. Additionally, surgery may be considered for patients who have tried other treatments without success and have a significant reduction in their quality of life due to their symptoms. It is important for patients to consult with their healthcare provider to determine the best treatment option for their individual case.

Timeline

Before surgery:

  1. Patient experiences symptoms such as pain, numbness, and weakness in the shoulder, arm, and hand.
  2. Patient undergoes diagnostic tests such as electromyography (EMG) and nerve conduction studies to confirm the diagnosis of thoracic outlet syndrome.
  3. Patient may undergo physical therapy to improve symptoms and strengthen muscles in the affected area.

During surgery:

  1. Patient undergoes thoracic outlet syndrome surgery, which may involve removing a portion of the first rib, releasing tight muscles or ligaments, or removing any abnormal structures compressing the nerves or blood vessels in the thoracic outlet.
  2. Surgery is typically performed under general anesthesia, and may require a hospital stay of a few days.

After surgery:

  1. Patient undergoes a period of recovery and rehabilitation, which may involve physical therapy to regain strength and range of motion in the affected arm.
  2. Patient may experience some pain and discomfort in the surgical area, which can be managed with pain medications prescribed by the surgeon.
  3. Patient follows up with the surgeon for post-operative care and monitoring of symptoms to ensure that the surgery was successful in relieving their symptoms.
  4. Patient gradually resumes their normal activities and may experience a significant reduction in their symptoms over time.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with thoracic outlet syndrome surgery?
  2. What is the success rate of this surgery in terms of relieving symptoms and improving quality of life?
  3. What is the recovery process like after thoracic outlet syndrome surgery?
  4. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  5. How long will it take for me to see results or improvements after the surgery?
  6. Will I need physical therapy or rehabilitation after the surgery, and if so, for how long?
  7. Are there any long-term effects or considerations I should be aware of after thoracic outlet syndrome surgery?
  8. How experienced are you in performing this type of surgery, and what is your success rate with similar cases?
  9. Can you provide me with any patient testimonials or references who have undergone thoracic outlet syndrome surgery with you?
  10. Are there any lifestyle changes or modifications I should make before or after the surgery to help with my recovery and overall health?

Reference

Authors: Balderman J, Abuirqeba AA, Eichaker L, Pate C, Earley JA, Bottros MM, Jayarajan SN, Thompson RW. Journal: J Vasc Surg. 2019 Sep;70(3):832-841. doi: 10.1016/j.jvs.2018.12.027. Epub 2019 Mar 7. PMID: 30852035