Treatment of Thoracic Outlet Syndrome & Carpal Tunnel Syndrome ????

[tsaakin]

Hey physios,

I would appreciate if anyone could help me out with a treatment for thoracic outlet syndrome and carpal tunnel syndrome... Please include those for all the stages,,,

Cheers

[charlize29]

Sorry guys for the double reply..

[charlize29]

Hi,

For cervical ribs and scaleneus syndrome, as much as possible, conservative measures should be tried esp. for those cases which seem to improve with rest. To relieve the strain on the lower brachial plexus and roots the shoulder should be brought upward and backward with a sling or brace.Emphasis should be given on strengthening the trapezius muscles & levator scapulae muscles. Aggravating factors should be avoided and a change of occupation that does not strain the shoulder or arm will result in complete relief of symptoms. Postural exercises is a must. If it doesnt relieve and has no resposne to conservative measures then surgery is the only option for that.

Regards,
charlize29

[sdkashif]

For thoracic Outlet Syndrome :

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)

Mobilize the restricted nerve tissue by using the nerve mobilization maneuvers if nerve tension tests are positive.

For Carpal Tunnel Syndrome:

Modalities:

The use of modalities can be given to reduce swelling and pressure within the carpal tunnel. They of great benefit in improving the condition. Ice, ultrasound, iontophoresis, phonophoresis, LASER can be used with great success.

Stretching and Strengthening:

A specific strengthening and stretching exercise programme can improve the strenght and dexterity of hand.

Massage, Nerve gliding and Neural Tension:

Massage, nerve gliding and neural tension techniques can be give but their results are unproven and give no real benefit.

Mobilization of Median Nerve. Mobilize the median nerve if neural tension tests are positive. The procedure for that is as follows. Begin with the pateint supine; sequentially apply the shoulder girdle depression, then slightly abduct the shoulder, extend the elbow, laterally rotate the arm and supinate the forearm. Wrist, fingers and thumb extensions are then added; finally the shoulder is taken in to greater abduction. The full stretch position include contralateral cervical side flexion. Whiile maintaining the stretch position, move one joint at a few degrees in and out of stretch position, such as wrist flexion and extension, or elbow flexion and extension. This maneuver is beneficial when examining and treating the symptoms related to median nerve distribution, problems with shoulder girdle depression ( such as thoracic outlet syndrome, carpal tunnel syndrome.


Manipulation:

Manipulative techniques used to stretch & manipulate the carpal tunnel give benefit and improve the condition, although they are not widely accepted.

Ergonomic Advice:

Work sit eassessment help to reduce potential excerbating factors (such as poor posture, excessive force).

Wrist Splints:

Patients with mild to moderate CTS respond well to the conservative programme of night time splintting in neutral position for a minimum of 3-4 weeks and is the best evidence based practice in use.

I think that this will be of help to you.

[rahul]

hi
can u please tell about,tendon gliding & median nerve gliding in carpel tunnel syndrome

[P.T.]

hi,sdkashif
u said

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

what is the spray therapy???
thanx

[sdkashif]

Stretch and spray therapy is one of the popular and effective treatment methods used in the management of myofascial pain syndromes and myofascial trigger points in muscles; hence so will be effective the myofascial component of the thoracic outlet syndrome. Vapocoolants are used in the spray, the two most commonly used are ethyl chloride and Fluori Methane sprays. The sequence of steps used in the stretch and spray of any muscle for myofascial trigger point is as follows.

Patient is supported in a comfortable relaxed position. One end of muscle is anchored. Skin is sprayed with rapid parallel sweeps of vapocoolant over the length of muscle in the direction of pain pattern. All of the muscle is covered. Immediately after the first sweep of spray, pressure is applied to stretch the muscle and is continued as spray is applied. Sweeps of spray are continued to cover the referred pain pattern of that muscle. All this is repeated two to three times or less if the passive range of motion becomes maximum. Hot pack and several cycles of active full range of motion follows.

[Yarok]

hi

instead of spray and stretch very good results acheive(after Chaitow) using
ischemic pressure followed by positional release and postisometric relaxation.

thanks
Yaro