Thoracic outlet syndrome (TOS) is a condition caused by the compression of neurovascular structures within the thoracic outlet. The primary objective of this systematic review is to evaluate evidence-based diagnostic and therapeutic methods for TOS, with a specific focus on physiotherapy-based interventions. Secondly, this study aims to synthesize recent academic findings to provide medical professionals with a contemporary perspective on effective treatment protocols and to highlight gaps in the existing literature warranting further research. Following the PRISMA framework, a digital search of major platforms, including PubMed, MEDLINE, and Google Scholar, was conducted for literature published up to April 2026. Ten articles met the inclusion criteria, which focused on neurogenic, arterial, and venous subtypes and prioritized physiotherapy-based interventions. Methodological quality was assessed using validated tools such as QUADAS-2, AXIS, and ROBINS-1. The results demonstrate that structured physiotherapy, including postural correction, stretching of the scalenes and pectoralis minor, scapular stabilization, and neural mobilization, is highly effective as a primary conservative treatment for reducing pain and improving upper limb function. Intensive inpatient rehabilitation programs also showed significant, sustained improvements in strength and functional capacity. Additionally, the review highlights that persistent symptoms are often influenced by psychosocial factors such as central sensitization and kinesiophobia, necessitating a multidisciplinary, biopsychosocial approach to management. Despite these findings, the review identifies a significant lack of standardized diagnostic and therapeutic protocols. The study concludes that early identification and the integration of pain neuroscience education into standardized rehabilitation protocols are essential for optimizing patient outcomes and preventing symptom recurrence.
Joshi et al. (Mon,) studied this question.