Sep 15, 2017 the subject matter of this course will include 1 a clinical breakdown of thoracic outlet syndrome, 2 differential diagnosis of thoracic outlet syndrome, 3 clinical patterns for vascular and neurogenic components of thoracic outlet syndrome with evid. Identification of thoracic outlet syndrome is complex and a thorough clinical examination in addition to appropriate clinical testing can aide in diagnosis. Thoracic outlet syndrome tos is a group of symptoms that occur when blood vessels or nerves in the space between your collarbone and your first rib thoracic outlet are squeezed. This overall management program for thoracic outlet compression syndrome is based upon experience with 153 extremities in 149 patients and the results of others. Manual techniques to reposition rib cage and decrease postural asymmetries. It was previously designated according to presumable etiologies.
General principles of physical therapy that stem from these findings are suggested, and a specific protocol for the physical therapy regimen is given. Thoracic outlet syndrome tos is defined as the compression of nerves or blood. Thoracic outlet syndrome is very controversial in the medical literature. Conservative treatment for thoracic outlet syndrome. Exercises for thoracic outlet syndrome the university health. Thoracic outlet syndrome, a group of diverse disorders, is a collection of symptoms in the shoulder and upper extremity area that results in pain, numbness, and tingling. Thoracic outlet syndrome treatment algorithm bmj best. Despite many reports of operative and nonoperative interventions, rigorous scientific investigation of this syndrome leading to evidencebased management is lacking. A series of physical therapy protocols is proposed for patients with thoracic outlet syndrome. This presentation was created by walt lingerfelt, fellow in training at evidence in motion. Tweetintroduction the condition discussed in this article, you will come to find, is quite complex and can be a battle for the physiotherapist and physical therapist.
Your health care provider will recommend the treatment option that is right for you. Physical medicine and rehabilitation for thoracic outlet. The method selected depends on the pathology and type of thoracic outlet syndrome as detailed above, as well as surgeon preference. The diagnosis and treatment of patients with thoracic outlet syndrome has been. Thoracic outlet syndrome leading physiotherapy provider. Acr appropriateness criteria thoracic outlet syndrome. Even the name itself has been questioned because the actual site of pathology is technically the thoracic. Maintenance prom to involved shoulder elevation, er90, ir90 as tolerated. Thoracic outlet syndrome rehabilitation protocol tmi sports. While there are many clinical studies concerning the efficacy of surgical treatment, there are few regarding conservative treatment. Early identification of tos can help improve the success of treatment. Thoracic outlet syndrome is a complex condition in which blood vessels andor nerves are entrapped or compressed as they exit the thorax. If you would like to discuss treatment with an experienced therapist at michigan medicine contact michigan medicine physical therapy at 7349367070.
Tos can be grouped as neurogenic and vascular, depending on the anatomical structure that is compromised. It results from the compression of structures in the thoracic outlet, a space just above the first rib, and behind the clavicle collar bone. Physical therapy increases the range of motion of the neck and shoulders, strengthens muscles and promotes better posture. Thoracic outlet syndrome tos management and treatment. Occupational therapy preoperative conservative management. Management ranges from conservative with advice regarding posture, physiotherapy and multimodal analgesia to surgical intervention. The term thoracic outlet syndrome is used to describe a condition of compression of the nerves andor blood vessels in the region around the neck and collarbone, called the thoracic outlet. Venous thoracic outlet syndrome progressing to the point of axilosubclavian vein thrombosis, variously referred to as pagetschroetter syndrome or. Surgical management of nerve compression is indicated in individuals that show physical signs of nerve. C many different symptoms may occur with this condition. Venous thoracic outlet syndrome progressing to the point of axilosubclavian vein thrombosis, variously referred to as pagetschroetter syndrome or effort thrombosis, is a classic example of an.
Physiotherapy is aimed at reducing symptoms and preventing reoccurrence in the future. A protocol of treatment for the physical therapy management of the thoracic outlet syndrome has been established at. Thoracic outlet syndrome tos is a condition that is somewhat controversial and there are no clearcut clinical guidelines as regards the best way to manage this condition. Physiotherapy is used to open up the space between the clavicle and first rib, improve posture, strengthen the shoulder girdle, and loosen the neck muscles. Physiotherapy for thoracic outlet syndrome physiotherapy can be very effective in treating thoracic outlet syndrome. The pathology, signs, and symptoms of the specific aspects of the tos this protocol of treatment for the physical therapy management of the thoracic outlet syndrome was presented at the humera society meeting in bermuda on. Thoracic outlet syndrome tos is an umbrella term that describes three related syndromes caused by nerve compression in the upper body, specifically the nerves in the neck, chest and arms. For most cases of disputed neurological thoracic outlet syndrome, initial management is conservative and includes physiotherapy. Thoracic outlet syndrome is considered to be a collection of quite diverse syndromes rather than a single entity yanaka et al.
Treatment for neurogenic thoracic outlet syndrome typically begins with physical therapy. Thoracic outlet syndrome tos is complex clinical entity characterized by various neurovascular signs and symptoms of the upper limb. Thoracic outlet syndrome exercises ii thoracic outlet syndrome occurs when the nerves and blood vessels that come from your chest to your arm are pinched. Thoracic outlet syndrome brigham and womens hospital. Thoracic outlet syndrome refers to a condition whereby blood vessels andor nerves that pass into the arms from the neck are compressed, due to narrowing of the thoracic outlet which is the space. It is a congenital abnormality located above the normal first rib.
This weakens the blood circulation in the neck, shoulder and arm. Thoracicoutlet syndrome refers to compression of the subclavian vessels and brachial plexus at the superior aperture of the thorax. Thoracic outlet syndrome tos is a potentially painful and disabling condition of the upper extremity. The subject matter of this course will include 1 a clinical breakdown of thoracic outlet syndrome, 2 differential diagnosis of thoracic outlet syndrome, 3 clinical patterns for vascular and neurogenic components of thoracic outlet syndrome with evidencebased intervention options, and 4 case studies designed to assist clinicians in matching. Treatment of thoracic outlet syndrome physiotherapy management is often sufficient to manage tos. Advice to stop any chest bench press, push ups, or. Abstract analysis of 155 operations in 8 patients with thoracic outlet syndrome demonstrates the validity of resection of the first rib as the optimal. Objective diagnosis ulnar nerve conduction velocity and current therapy of the thoracic outlet syndrome harold c. Bahram jam, pt advanced physical therapy education institute aptei, thornhill, on, canada january 3, 2017 article published on. Thoracic outlet syndrome approach bmj best practice. Thoracic outlet syndrome assessment and physical therapy. The term thoracic outlet syndrome describes compression of the neurovascular structures as they exit through the thoracic outlet cervicothoracobrachial region. The thoracic outlet syndrome tos is a disputed syndrome in the field of the socalled compression syndromes of the upper extremity.
Your physiotherapist will assess you but further diagnostic tests may be needed to diagnose thoracic outlet syndrome. This case study was designed to evaluate the effect of manual therapy, postural correction and acupuncture like tens acutens in the management of tos. The effect of manual therapy, postural correction and. Previous training in orthopedic manual therapy is a prerequisite to employing this approach to the treatment of the thoracic outlet syndrome. It includes several different types of disorders, as follows. This area is bordered by the collar bone, side of the neck, shoulder blade and top. The goals of treatment are to reduce symptoms and pain. Thoracic outlet syndrome treatment guidelines michigan medicine. Jan 05, 2017 the term thoracic outlet syndrome tos was originally coined in 1956 by rm peet.
Information for patients who have been diagnosed with. Anterior scalene middle scalene posterior scalene brachial plexus clavicle first rib. Thoracic outlet syndrome tos is the term given to the condition in which there is compression of the neurovascular structures nerves, arteries and veins as they exit the thoracic outlet neck to the armpit and into the arm. Thoracic outlet syndrome treatment options exercises you can do where to learn more information for patients who have been diagnosed with thoracic outlet syndrome. Conservative treatment of thoracic outlet syndrome a. Techniques include catheterdirected thrombolysis and surgical decompression of the thoracic outlet. Compression of each of these structures results in characteristic symptoms divided into three variants.
Isolated venous type of thoracic outlet syndrome presents with unilateral upper extremity edema, pain, cyanosis, paresthesia, fatigue, and heaviness of the ue 5 isolated arterial type of thoracic outlet syndrome presents with cool extremities, absent arterial pulse, possible distal gangrene, muscle cramps in the hand, paresthesia, swelling. The term thoracic outlet syndrome tos was originally coined in 1956 by rm peet. Patient will have one to two visits with an occupational therapist with an. Neurologic tos classic true neurologic tos common disputed neurologic tos vascular tos arterial tos venous tos combined neurovascular tos. Certain orthopaedic manual therapy procedures are utilized to increase the mobility of specific areas of the patients shoulder girdle, upper thorax, and if indicated, the cervical and upper thoracic spine. Thoracic outlet syndrome treatments pursuit physical therapy. Physical therapy can also strengthen muscles, improve flexibility, decrease pain, and promote good posture, which can decompress the. Modalities with deep heat eg, therapeutic ultrasound, electric stimulation, superficial heat eg, hydrocollator packs, stretching exercises, postural correction exercises, and strength and endurance exercises are all useful or necessary components of thoracic outlet syndrome treatment. Due to the range of signs and symptoms that can lead to a diagnosis of tos, the incidence rates of the condition currently are unknown. Thoracic outlet syndrome refers to compression of the subclavian vessels and brachial plexus at the superior aperture of the thorax.
Thoracic outlet syndrome is caused by a compression of the brachial plexus or subclavian vessels as they exit the neck into the shoulder region and pass under the first rib. Longterm functional outcome of surgical treatment for. Welcome to total physios patient resource about thoracic outlet syndrome. Experts at nyu langones rusk rehabilitation provide therapy to reduce compression of arteries, veins, and nerves. Therapy then addresses tight muscles, with strengthening of weakened neck and shoulder girdle muscles. Thoracic outlet syndrome neck stretch physiotherapy patient information the james cook university hospital, marton road, middlesbrough, ts4 3bw. Several treatment options are available, including surgery. Thoracic outlet syndrome called tos in this pamphlet is a common but. Conservative management of thoracic outlet syndrome part 1. Treatments include a variety of exercise to mobilise and stretch the soft tissue and neural structures associated with tos, 1st rib mobilisation, myofascial releases and trigger point therapy, taping or bracing the shoulder girdle. Thoracic outlet syndrome tos refers to a condition involving the compression of nerves and blood vessels as they pass through a part of the body called the thoracic outlet. Thoracic outlet syndrome tos is a controversial topic in the literature. There is no one test to accurately diagnose tos, and other conditions can have similar symptoms.
Conservative treatment of thoracic outlet syndrome consists initially of pain control and medicinal and physical measures. The presence of a cervical rib can cause a form of thoracic outlet syndrome due to compression of the brachial plexus or subclavian artery. Surgical management can vary from excision of soft tissue or bony. Thoracic outlet syndrome tos is the clinical entity that occurs with compression of the brachial plexus, subclavian artery, andor subclavian vein at the superior thoracic outlet.
Surgical management of nerve compression is indicated in individuals that show physical signs of nerve damage or who have failed conservative treatments. Oct 05, 2012 tweetintroduction the condition discussed in this article, you will come to find, is quite complex and can be a battle for the physiotherapist and physical therapist. Thoracic outlet syndrome symptoms, diagnosis and treatment. Pillastrini 5 thoracic outlet syndrome tos is a debated topic. Learn more about thoracic outlet syndrome and find out if your shoulder pain or collarbone pain is because of tos. The anatomic findings dictating certain physical therapeutic approaches are outlined. Thoracic outlet syndrome occurs when the nerves and blood vessels that come from your chest to your arm are pinched. Jun 03, 2018 thoracic outlet syndrome tos is an umbrella term that describes three related syndromes caused by nerve compression in the upper body, specifically the nerves in the neck, chest and arms. If suspected diagnosis of vascular tos upon physical therapy examination of the. Thoracic outlet syndrome called tos in this pamphlet is a common but challenging condition that affects the front of the shoulder and neck area, just below the v where they meet. Thoracic outlet syndrome tos refers to a constellation of symptoms caused by compression of the. See more ideas about massage therapy, thoracic outlet syndrome exercises and physical therapy.
These nerves and blood vessels can be pinched under your collar bone, along your chest wall, or in your neck muscles. Physiotherapy in hamilton for thoracic outlet syndrome. Range of motion and nerve gliding exercises are instituted simultaneously, and the patient is educated in proper posture and ergonomics at home and in. Exercises for thoracic outlet syndrome read this pamphlet to learn more about. The thoracic outlet is marked by the anterior scalene muscle anteriorly, the middle scalene posteriorly, and the first rib inferiorly. The following conclusions are documented and discussed. Objective diagnosis ulnar nerve conduction velocity and. The most common initial treatment for neurogenic thoracic outlet syndrome is physical therapy. It is a condition that can develop after a limb trauma and appears mostly in one or more limbs. Anatomy outlet is composed of 5 successive spaces the vascular and nervous elements go through.
Thoracic outlet syndrome tos is one of the most controversial diagnoses in clinical medicine. The specific structures compressed are usually the nerves of the branchial plexus and. Thoracic outlet syndrome tos can cause pain and numbness in the shoulder, arm, and hand. Rehabilitation of patients with thoracic outlet syndrome. Conservative management of thoracic outlet syndrome part 1 view the presentation. An appropriate physical therapy program for thoracic outlet. Apr 29, 2019 thoracic outlet syndrome, a group of diverse disorders, is a collection of symptoms in the shoulder and upper extremity area that results in pain, numbness, and tingling. Thoracic spine joint mobilizations to encourage thoracic extension in upright posture. The pathology, signs, and symptoms of the specific aspects of the tos this protocol of treatment for the physical therapy management of the thoracic outlet syndrome was presented at the humera society meeting in bermuda on april 23. The simple definition of thoracic outlet syndrome is neurovascular symptoms in the upper extremities due to pressure on the nerves and vessels in the thoracic outlet area. Thoracic outlet syndrome treatments vary, depending on the type of tos you have and your symptoms.
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