Thoracic Outlet Syndrome

I need a effective treatment technique for Thoracic Outlet Syndrome. The patient is a 18 year old female, with no major complications.

Strengthening upper trapezius (shoulder shrugging exercises) are the usual way to go. Must admit the few I have seen responded fairly quickly to this. This might be worth a post in the musculoskeletal section to get more replies.

Use modalities to treat pain. You may use any one of them. These are superficial heating methods like Infrared, electrical heating pads, moist heat packs, etc & deep heating methods which are SWD, Micro wave diathermy, ultrasound. TENS and Interferential are also helpful.

Strength and endurance training exercises for the shoulder elevators.

Stretching exercises especially for the scalene muscles and pectoralis minor.

Posture correction exercises

Moblization and manipulation procedures to address the joint stiffness in the spine. (Moblization of the first rib)

Stretch and spray therapy as described by Jenet Travell and D.G. Simon ( Myofascial pain and Dysfunction)

I think that this will be of help to you.

Firstly here's an overview of TOS gained from various websites. This should give you a starting point for a more specific assessment of the causative factors, before deciding on a treatment approach.

Thoracic outlet syndrome is actually a collection of syndromes brought about by abnormal compression/pressure on the nerves and vessels in the thoracic outlet area. This is usually caused by bony, ligamentous or muscular obstacles between the cervical spine and the lower border of the axilla. The specific structures compressed are usually the nerves of the branchial plexus and occasionally the subclavian artery or subclavian vein.

Vascular symptoms include:

1.&nbsp &nbsp &nbsp &nbsp Swelling or puffiness in the arm or hand
2.&nbsp &nbsp &nbsp &nbsp Bluish discoloration of the hand
3.&nbsp &nbsp &nbsp &nbsp Feeling of heaviness in the arm or hand
4.&nbsp &nbsp &nbsp &nbsp Pulsating lump above the clavicle
5.&nbsp &nbsp &nbsp &nbsp Deep, boring toothache-like pain in the neck and shoulder region which seems to increase at night
6.&nbsp &nbsp &nbsp &nbsp Easily fatigued arms and hands
7.&nbsp &nbsp &nbsp &nbsp Superficial vein distention in the hand

Neurological symptoms include:

1.&nbsp &nbsp &nbsp &nbsp Parasthesia along the inside forearm and the palm (C8, T1 dermatome)
2.&nbsp &nbsp &nbsp &nbsp Muscle weakness and atrophy of the gripping muscles (long finger flexors) and small muscles of the hand (thenar and intrinsics)
3.&nbsp &nbsp &nbsp &nbsp Difficulty with fine motor tasks of the hand
4.&nbsp &nbsp &nbsp &nbsp Cramps of the muscles on the inner forearm (long finger flexors)
5.&nbsp &nbsp &nbsp &nbsp Pain in the arm and hand
6.&nbsp &nbsp &nbsp &nbsp Tingling and numbness in the neck, shoulder region, arm and hand

Compression occurs when the size and shape of the thoracic outlet is altered. The outlet can be altered by exercise, trauma, pregnancy, a congenital anomaly, an exostosis, postural weakness or changes.

Depending on the exact site of injury and the injury component of the neurovascular bundle, three distinct syndromes or a combination thereof may be encountered. One, neurological syndrome - Two, arterial syndrome - Three, venous syndrome. Each will have varying signs and symptoms. For more information have a look at the Thoracic Outlet Syndrome Website.

Below is a list of the component syndromes which comprise thoracic outlet syndrome along with a brief description of each.

Anterior scalene tightness

Compression of the interscalene space between the anterior and middle scalene muscles-probably from nerve root irritation, spondylosis or facet joint inflammation leading to muscle spasm.

Cervical Rib Syndrome

A variation of the Scalenus Anticus Syndrome is the Cervical Rib Syndrome. In this syndrome, it is an osseous anomaly, not muscular hypertrophy, that is responsible for the compression. Cervical ribs are hereditary elongations of the transverse processes of the C7 vertebrae. They may be unilateral or bilateral.

Costoclavicular approximation

Compression in the space between the clavicle, the first rib and the muscular and ligamentous structures in the area-probably from postural deficiencies or carrying heavy objects.

Pectoralis minor tightness

Compression beneath the tendon of the pectoralis minor under the coracoid process-may result from repetitive movements of the arms above the head (shoulder elevation and hyperabduction).

Thanks physiobase for adding valuable reply.

Let me also add the link to this useful article about the edgelow procedure in treatment of thoracic outlet syndrome.


eeshop.unl.edu/text/findadoc.txt

Originally Posted by sdkashif Use modalities to treat pain. You may use any one of them. These are superficial heating methods like Infrared, electrical heating pads, moist heat packs, etc & deep heating methods which are SWD, Micro wave diathermy, ultrasound. TENS and Interferential are also helpful. Strength and endurance training exercises for the shoulder elevators. Stretching exercises especially for the scalene muscles and pectoralis minor. Posture correction exercises Moblization and manipulation procedures to address the joint stiffness in the spine. (Moblization of the first rib) Stretch and spray therapy as described by Jenet Travell and D.G. Simon ( Myofascial pain and Dysfunction) I think that this will be of help to you.

I am wondering where you usually use the modalities for pain? They may have pain totally unrelated to the structure at fault.

I have a same age female client. I have TOS in my mind. Therefore, I educate her about the posture and avoiding aggravating activities. SHe had tight scalenes and pec minor, I gave her the streching ex's. I also gave her the scapular retractors strengthening ex's. SHE also has winging of scapular, esp when she lowering her arm. So serratus ant activation ex's. After 1st visit, she reported her symtoms slightly worse. We may irritate her by doing assessment. I will see how she is doing when she visit me next time. I'll let you know.

She doesn't like the heat and TENS. Her upper trapezius is obvious hypertrophy ( she has the condition for 2 years). Anybody can give me some clue, why this happened? If the shoulder shrug still approprate? and if the patient get worse again or do not getting better, should I refer her to the physician to seek surgery help, because she had sensation change , thumb numbness and C6 myotome very mild weakness before she saw me.