Which management approach is NOT considered a conservative measure for TOS according to Souza?

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Conservative management of thoracic outlet syndrome focuses on addressing soft-tissue restrictions and biomechanical faults that narrow the outlet. The goal is to relieve compression by releasing tight muscles, improving posture, and increasing flexibility so the neurovascular structures pass through the space more freely. Myofascial therapy helps release tight scalene and surrounding fascia that can crowd the thoracic outlet. Postural training corrects alignment issues like forward head posture and rounded shoulders that reduce the outlet space and alter scapular mechanics. Stretching the pectoral muscles and scalene muscles directly reduces their tightness, which often contributes to narrowing of the thoracic outlet.

Cervical traction, on the other hand, is not typically used as a conservative approach for TOS because it does not target the specific outlet-level compression or the tight soft tissues responsible for narrowing the space. It can place forces on the cervical spine and plexus in ways that may not alleviate—and could potentially aggravate—neurovascular symptoms in TOS. When conservative measures fail or symptoms are due to fixed bony or vascular issues, more invasive options or surgical decompression may be considered.