One of the most important factors in improving the symptoms and treatment outcomes of TOS is for the patient to recognize the need for possible lifestyle changes before, during and after treatment, along with finding a TOS experienced healthcare provider as early as possible. Lifestyle modifications can bring about recognizable improvement in pain, function and quality of life. Becoming educated about TOS empowers the patient and increases the potential for improvement.

Conventional medical intervention may be only part of your TOS treatment program. Alternative Medicine, lifestyle modification, fitness, nutrition and relaxation techniques play an important role in helping you live a fulfilling life with Thoracic Outlet Syndrome.

Treatment for Thoracic Outlet Syndrome begins with getting a correct diagnosis by a physician experienced in diagnosing and treating Thoracic Outlet Syndrome patients. Sometimes patients will begin treatment for TOS only to find out that TOS is not the correct diagnosis. This is why it is imperative that you seek out a TOS experienced practitioner initially so that you have a better chance of a more accurate diagnosis and treatment.

Your treatment plan depends on what type(s) of TOS you may have and if your symptoms are life and/or limb threatening. If you are experiencing life and/or limb threatening symptoms, your TOS experienced physician may recommend surgery initially. If your physician determines that your case is not life or limb threatening, physical therapy is generally thought to be the next step.

There are indications and contra-indications for every treatment modality and you should discuss each and every treatment option you choose with your provider. Every patient is different and will respond differently to treatment. Both surgical and non surgical outcomes vary with every patient.

Aqua Therapy
Water therapy consists of an exercise program that is performed in the water. Aquatic therapy uses the physical properties of water to assist in patient healing and exercise performance.

Botox (Botulinum) Injections
Botox injections are used to treat upper extremity pain by targeting certain muscles. Most often, Botox is injected into the scalenes with varied reports of success. Some patients state relief of pain and continue ongoing Botox injections while other report no or non-sustained relief after first or multiple injections. Botox injections do have serious risks and you should always discuss these risks with your physician. It is generally recommended that physicians performing BOTOX injections use additional visual guidance.

Cardiopulmonary Exercises
It is important to keep as fit as possible in general but living with Thoracic Outlet Syndrome brings unique challenges to becoming and staying physically fit. Walking provides improved cardiopulmonary function as well as releases important "feel good" endorphins. Some patients have advocated an almost total relief of pain while walking. Before undergoing any excersize program discuss the risks and benefits with your healthcare provider.

Chiropractic Medicine
A form of alternative medicine, Chiropractors focus on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic care is used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, and pain in the joints of the arms or legs, and headaches.

Feldenkrais
This method is designed to improve movement, aiming to expand and refine the use of self awareness, in order to reduce pain or limitations in movement, and promote general well-being. Success reports vary with every patient.

Lifestyle Changes
A diagnosis of Thoracic Outlet Syndrome may require lifestyle changes, modifications and adaptations. A change in work environment, reduction in computer use, reduction in heavy lifting, reducing family stress are just a few examples of lifestyle changes TOS patients may require to reduce the amount of every day pain and pain flairs.

Massage Therapy
The manipulation of muscles and connective tissue to enhance the function and promote relaxation and well-being is something some TOS patients advocate. Massage therapy can include targeting muscles of the upper extremity, neck and chest as well as other areas of the body and the lymphatic vessels. All life and limb threatening conditions such as a clot or aneurysm should be ruled out first by a licensed physician prior to undergoing any therapy.

Pharmacological Management
Medication management consists of integrating effective narcotics, anti-depressants, muscle relaxers, anti-inflammatories and others. Commonly used medications to treat neurovascular upper arm pain may include Pregabalin (Lyrica®), Duloxetine (Cymbalta®), Gabapentin (Neurontin®), Coumadin (blood thinner), Tramadol, Amitriptyline, Valium, Ativan, Norco, Ambien, BioFreeze, Diluadid, Lidoderm Patch, Fentanyl, Flexeril, Opana and more. Some patients in authorizing states have advocated the use of Medicinal Marijuana for pain relief.

Physical Therapy
A physical therapist will assess your condition, posture, and make recommendations accordingly. Improving posture is important in relieving symptoms of TOS. It is important for you to remember that if you experience any pain when performing any physical therapy, you should alert your therapist immediately.

Psychological Support
Learning to live with a chronic pain is often an emotional challenge. Because Thoracic Outlet Syndrome is poorly understood, this makes coping even more difficult. The TOS patient needs to ensure an emotionally sound environment with caring friends and family members to assist in living with this difficult condition. Counseling sessions with a trained mental health professional is important if the patient is feeling depressed, suicidal or needs emotional support and guidance. If you're suicidal or having suicidal thoughts please seek help immediately.

Postural Support Devices

Sleep management
Restful sleep is important to our health and helps us recuperate our body and mind. Sleeplessness can lead to imbalances of our entire system. A healthy sleep routine can contribute greatly to our physical and mental well-being. Getting sufficient sleep ranks among the best defense mechanisms we have to stay healthy and handle our stress. Sleep can be difficult with Thoracic Outlet Syndrome as positioning to relief pain can prove difficult. Patients have reported numerous techniques in helping to achieve a good night's rest, from memory foam mattresses to specialized pillows, each patient needs will be different.

Spinal Cord Stimulators
Spinal Cord Stimulators are used to send pulsed electrical signals to the spinal cord to control chronic pain. Spinal cord stimulation (SCS) uses stimulating electrodes implanted in the epidural space controlled by an electrical pulse generator implanted in the lower abdominal area or gluteal region. SCS has been used to treat the upper extremity pain with varied reports of success in relieving pain.

Surgery
Surgical intervention may be offered as a last resort if all previous treatment has failed to reduce your symptoms. Patients may be offered surgery initially if symptoms are life or limb threatening. Surgery for Thoracic Outlet Syndrome does have lifelong serious risks and you should thoroughly discuss these risks with your TOS experienced surgeon. Your surgeon may require you to complete additional pre-surgery treatments and procedures prior to surgery. Surgery is of much debate and outcomes vary with every patient.

Transcutaneous Electrical Nerve Stimulation (TENS)
A "TENS unit" sends electrical impulses to involved parts of the body to block pain signals. The electrical currents produced are mild, but may prevent pain messages from being transmitted to the brain.

Trigger Point Injections (TPI)
TPI is a procedure used to treat painful areas of muscle that contain trigger points caused by tense muscles.

Work Adaptation
Sometimes TOS patients must change employers, change careers or stop working all together to combat the daily pain flairs and disability that are often associated with Thoracic Outlet Syndrome. Workplace adaptation may prove beneficial.

Watsu
This water program is a gentle form of body therapy performed in warm water.  It combines elements of massage, joint mobilization, shiatsu, muscle stretching and other.

There may be other treatment options available.

This information was reviewed and edited by Dr. Wladislaw Ellis, M.D. TOS Specialist