We identified one study comparing natural progression with an active intervention.
This review was complicated by a lack of generally accepted criteria for the diagnosis of TOS and had to rely exclusively on the diagnosis of TOS by the investigators in the reviewed studies. Until high quality, randomized clinical trials comparing the various interventions for TOS are performed, the decision whether to treat and the choice of appropriate treatment will have to be based on the preferences of the individual and health care provider. This systematic review demonstrated that there is not enough evidence that the established interventions for TOS are helpful in relieving pain.
#Thoracic outlet syndrome armpit pain trial#
The trial comparing the intervention of BTX injection with placebo provided moderate evidence that this procedure does not significantly reduce pain or disability scores long term, although there were no adverse events associated with the procedure over placebo. There were no trials of surgery versus no treatment. There were no adverse effects in either group. We identified issues in study design that could have affected the outcome of the trial. There is very low quality evidence that removal of a rib reduced pain from 'disputed' TOS more than a neuroplasty procedure. A second trial analyzed 19 people who underwent double-blinded provision of a single injection of BTX (muscle relaxant) into the scalene muscles of the neck, and 18 people in the placebo group who received no active injection, with follow-up at six weeks, three months and, critically for the purpose of this review, six months. The participants had not responded to non-surgical treatments. One trial compared surgery to remove the first rib (transaxillary first rib resection) with surgery in which the surgeon freed the nerves from surrounding tissues (neuroplasty) without removing a rib, in 55 people with the disputed type of TOS. We wanted to discover whether any treatment is effective and whether treatments have any harmful effects.įrom our systematic search we identified two trials. We searched widely for clinical trials of treatments for TOS. Most people diagnosed with TOS have the disputed form. TOS is often diagnosed after other causes of one-sided symptoms of arm pain, weakness, loss of feeling, or all three, have been ruled out. There is a lack of widely accepted standards for making the diagnosis of TOS, so for the purpose of this review we decided to rely on the diagnosis of TOS made by the investigators in the reviewed studies. TOS is often associated with past injury. The various causes of TOS include an extra rib in the neck, differences in the shape of the bones of the spinal column, abnormal bands of tissue beneath the skin, and abnormalities of how muscles in the side of the neck attach to the bones. The person with TOS may have symptoms such as pain in the shoulder and neck that can spread into the arm and front of the chest weakness change in sensation swelling and a restricted blood supply to the affected arm. The term TOS represents three related syndromes: a form where the brachial plexus (a collection of nerves in the neck and armpit) is compressed a form where major blood vessels of the upper chest are compressed and painful non-specific or disputed TOS. TOS is one of the most controversial diagnoses in medicine. We reviewed the evidence about the effect of any treatment for thoracic outlet syndrome (TOS).
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