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Megan Rabe
Peter Emary


Evidence-Based Practice, Evidence-Based Case Report, Thoracic Outlet Syndrome


Objective: To illustrate how research findings can be used to inform the management of an individual patient.

Methods: A case scenario of a 29-year-old pregnant woman with a diagnosis of thoracic outlet syndrome (TOS) evoked a search of the PubMed database resulting in one randomized controlled trial (RCT) relevant to conservative versus surgical treatment. No systematic reviews were found. We appraised the RCT for its validity, importance, and applicability to informing a treatment plan for the patient.

Results: Surgical intervention for TOS was found to be favorable over conservative treatment. Combining the results with our patient’s clinical state and circumstances, we concluded that conservative therapy for the duration of her pregnancy should be recommended. Progressive neurological deficits or lack of symptom improvement six months post-partum would indicate a referral to her family physician for further evaluation and management.

Conclusion: We applied evidence from 1 recent RCT in formulating a management plan for a case of TOS.


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1. Nichols AW. Diagnosis and management of thoracic outlet syndrome. Curr Sports Med Rep. 2009;8(5):240–9. doi: 10.1016/j.thorsurg.2020.09.003
2. Laulan J, Fouquet B, Rodaix C, Jauffret P, Roquelaure Y, Descatha A. Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact. J Occup Rehabil 2011;21(3):366-73. doi: 10.1007/s10926-010-9278-9
3. Goeteyn J, Pesser N, Houterman S, van Sambeek MRHM, van Nuenen BFL, Teijink JAW. Surgery versus continued conservative treatment for neurogenic thoracic outlet syndrome: the first randomised clinical trial (STOPNTOS-trial). Eur J Vasc Endovasc Surg 2022;64(1):119-27. doi: 10.1016/j.ejvs.2022.05.003
4. Chandra V, Little C, Lee JT. Thoracic outlet syndrome in high-performance athletes. J Vasc Surg 2014;60(4):1012–8. doi: 10.1016/j.jvs.2014.04.013
5. George EL, Lee JT. Thoracic outlet syndrome, do women present differently than men? In: Hicks CW, Harris LM, editors. Vascular disease in women: an overview of the literature and treatment recommendations. Academic Press; 2021. p. 239–49.
6. Vanti C, Natalini L, Romeo A, Tosarelli D, Pillastrini P. Conservative treatment of thoracic outlet syndrome: A review of the literature. Eura Medicophys 2007;43(1):55–70.
7. Stilo F, Montelione N, Benedetto F, Spinelli D, Vigliotti RC, Spinelli F. Thirty-year experience of transaxillary resection of first rib for thoracic outlet syndrome. Int Angiol 2020;39(1):82–8. doi: 10.23736/S0392-9590.19.04300-1
8. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based Medicine: How to Practice and Teach EBM. 2nd ed. London: Churchill Livingstone; 2000.
9. Haneline MT. Evidence-Based Chiropractic Practice. Sudbury, MA: Jones and Bartlett; 2007.
10. D’Youville University School of Health Professions. Doctor of Chiropractic (DC), 3.5-year. Available at: Accessed September 13, 2022.
11. Bolton J. Evidence-based case reports. J Can Chiropr Assoc 2014;58(1):6-7.
12. Lisi AJ, Bhardwaj MK. Chiropractic high-velocity low-amplitude spinal manipulation in the treatment of a case of postsurgical chronic cauda equina syndrome. J Manipulative Physiol Ther 2004;27(9):574-8. doi: 10.1016/j.jmpt.2004.10.002
13. Emary PC. Evidence-based prognostication in a case of sciatica. J Can Chiropr Assoc 2015;59(1):24-9.
14. Emary PC. Diagnosis of a 64-year-old patient presenting with suspected lumbar spinal stenosis: an evidence-based case report. J Can Chiropr Assoc 2015;59(1):46-52.
15. Godlee F. Applying research evidence to individual patients. Evidence based case reports will help. Br Med J 1998; 316(7145): 1621-1622. doi: 10.1136/bmj.316.7145.1621
16. Twa MD. Evidence-based case report guidance. Optom Vis Sci 2022;99(2):93-94. doi: 10.1097/OPX.0000000000001869
17. Green BN, Johnson CD. How to write a case report for publication. J Chiropr Med 2006;5(2):72-82. doi: 10.1016/S0899-3467(07)60137-2
18. Delaney PM, Fernandez CE. Toward an evidence-based model for chiropractic education and practice. J Manipulative Physiol Ther 1999;22(2):114-118. doi: 10.1016/s0161-4754(99)70117-x
19. LeFebvre R, Peterson D, Haas M. Evidence-based practice and chiropractic care. J Evid Based Complementary Altern Med 2012;18(1): 75-79. doi: 10.1177/2156587212458435
20. Miller PJ, Jones-Harris AR. The evidence-based hierarchy: is it time for change? A suggested alternative. J Manipulative Physiol Ther 2005;28(6):453-7. doi: 10.1016/j.jmpt.2005.06.010
21. Critical Appraisal Skills Programme. CASP Checklists. Available at: Accessed August 23, 2022.
22. Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: Longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 2003;4:11. doi: 10.1186/1471-2474-4-11
23. The DASH Outcome Measure. Disabilities of the arm, shoulder and hand. Available at: Accessed November 1, 2022.
24. Gillard J, Pérez-Cousin M, Hachulla E, Remy J, Hurtevent JF, Vinckier L, Thévenon A, Duquesnoy B. Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine 2001;68(5):416-424. doi: 10.1016/s1297-319x(01)00298-6
25. Ochuba AJ, Mallela D, Feghali J, Lubelski D, Belzberg AJ, Hicks CW, Abularrage CJ, Lum YW. Development and validation of a prediction model for outcomes after transaxillary first rib resection for neurogenic thoracic outlet syndrome following strict Society for Vascular Surgery Diagnostic Criteria. J Vasc Surg 2022;77(2):606-615. doi: 10.1016/j.jvs.2022.10.014
26. Kim SW, Jeong JS, Kim BJ, Choe YH, Yoon YC, Sung DH. Clinical, electrodiagnostic and imaging features of true neurogenic thoracic outlet syndrome: Experience at a tertiary referral center. J Neurol Sci 2019;404:115-123. doi: 10.1016/j.jns.2019.07.024
27. Dessureault-Dober I, Bronchti G, Bussières A. Diagnostic accuracy of clinical tests for neurogenic and vascular thoracic outlet syndrome: a systematic review. J Manipulative Physiol Ther 2018;41(9):789-799. doi: 10.1016/j.jmpt.2018.02.007
28. Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropr Med 2006;5(3):101-17. doi: 10.1016/S0899-3467(07)60142-6