A diagnosis is made during a consultation with a Vascular Surgeon. Dr. Bhamidi will usually organise for an X-ray, Duplex Ultrasound scan or an MRI to visualise the exact location of problem within the thoracic outlet. Very occasionally, further tests or procedures (e.g. nerve conduction studies, angiogram or scalene muscle block) may also be needed.
When to Treat
Treatment is usually considered in TOS cases where there is a significant impairment to a person’s everyday function. Those in occupations that involve heavy and repetitive use of the arms, particularly in an overhead position, are least likely to respond to conservative, non-operative measures. All cases where there is evidence of compromise to the arterial or venous circulation should be referred for assessment and/or treatment.
Treatment for Neurogenic TOS generally starts with conservative, non-operative treatment such as physiotherapy and massage. In cases where this fails, and for venous and arterial TOS cases, treatment primarily comprises of resection of the scalene muscle and surgical decompression of the thoracic outlet. This may also involve resection of any cervical (extra) ribs or the first rib itself. In cases where the artery or vein is occluded after decompressing the thoracic outlet, additional surgery or procedures to reconstruct or bypass the artery or vein may be needed.