If you have problems viewing pdf files, download the latest version of adobe reader. Thoracic outlet syndrome massachusetts general hospital. The specific type of treatment used may vary depending on the cause and severity of the condition. Common causes of thoracic outlet syndrome include physical trauma from a car accident. If is important that your physical therapist has experience. 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. Surgical treatment of thoracic outlet syndrome in young. Thoracic outlet syndrome treatment options exercises you can do where to learn more information for patients who have been diagnosed with thoracic outlet syndrome.
In venous or arterial thoracic outlet syndrome, your surgeon may deliver medications to dissolve blood clots prior to thoracic outlet compression. Apparently characterized by a rare incidence, it often remains unidentified, leading to inadequate diagnosis and treatment and to serious complications, such as invalidity. The generic term thoracic outlet syndrome tos is often used to describe a variety of symptoms associated with excessive frictioning of spinal nerves in the shoulder and brachial region. Introduction this document has been prepared by the colorado department of labor and employment, division of workers compensation division and should be interpreted within the context of guidelines for physiciansproviders treating injured workers with upper extremity involvement. Challenges in the treatment of thoracic outlet syndrome. Evidence for the treatment of thoracic outlet syndrome as of 2014 is poor. Thoracic outlet syndrome information page what research is being done. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand. It occurs when abnormal portions of bony or soft tissue in the lower neck region compress or irritate the nerves of the brachial plexus. The term thoracic outlet syndrome tos was introduced by peet et al. Thoracic outlet syndrome tos is one of the most controversial diagnoses in clinical medicine.
Thoracic outlet syndrome florida osteopathic medical. Venous tos 10%15% of tos cases is caused by subclavian vein compression between the clavicle and first rib within the costoclavicular space, resulting in the abrupt presentation of axillarysubclavian vein effort thrombosis pagetvon schroetter syndrome. Thoracic outlet syndrome tos is a complex disease typically presenting as a combination of several upper extremity symptoms. Thoracic outlet syndrome treatment exercises top 4 exercises. Despite many reports of operative and nonoperative. Surgery to treat thoracic outlet syndrome, called thoracic outlet decompression, may be performed using several different approaches, including.
This form of thoracic outlet syndrome is characterized by compression of the brachial plexus. Thoracic outlet syndrome tos is characterized by pain, paresthesias, and weakness in the upper extremity, which may be exacerbated by elevation of the arms or by exaggerated movements of the head and neck. This can cause pain in your shoulders and neck and numbness in your fingers. Frequently orthopedists, neurologists or chiropractors refer patients with a diagnosis of thoracic outlet syndrome. Thoracic outlet syndrome tos is a general term used to describe three conditions which occurs in the thoracic outlet, an area formed by the top ribs and the collarbone. Clinical manifestations, differentiation and treatment pathways. 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. Symptoms of tos may include muscle weakness, paresthesia, discoloration, swelling, numbness, and pain in the hand or arm, and muscle. Introduction this document has been prepared by the colorado department of labor and employment.
Thoracic outlet treatment will vary significantly depending on the structure causing your symptoms. The thoracic outlet is the space between your collarbone clavicle and your first rib. Treatment for thoracic outlet syndrome povlsen, b 2014. 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. Views differ regarding the patho genesis, diagnosis, and management of tos. The specific structures compressed are usually the nerves of the branchial plexus and. The diagnosis of thoracic outlet syndrome is often missed even by experienced doctors. Thoracic outlet syndrome tos management and treatment. Nov 26, 2014 thoracic outlet syndrome tos is one of the most controversial diagnoses in clinical medicine. Imaging of the patient with thoracic outlet syndrome. Combined surgical treatment of thoracic outlet syndrome. 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.
Hence published results of both conservative and surgical management vary greatly. Information for patients who have been diagnosed with. Thoracic outlet syndrome tos is one of the most controversial clinical entities in medicine. One of the reasons is that the symptoms can look a lot like other problems, such as muscle strain. The symptoms of thoracic outlet syndrome tos are pain, numbness and tingling of the upper extremity. Telehealth onlne physio australian residents only treatment options. I had arterial thoracic outlet syndrome tos caused by having an additional cervical rib. Physical therapy in our clinic for thoracic outlet syndrome.
Thoracic spine joint mobilizations to encourage thoracic extension in upright posture. Maintenance prom to involved shoulder elevation, er90, ir90 as tolerated. Thoracic outlet syndrome treatment guidelines michigan medicine. I had cervical and 1st rib resection on the right and left. 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. 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.
Previous training in orthopedic manual therapy is a prerequisite to employing this approach to the treatment of the thoracic outlet syndrome. Sep 12, 2019 thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib thoracic outlet are compressed. When tos is suspected, a working diagnosis is usually arrived at based on the entire clinical presentation, which could include the. Thoracic outlet syndrome tos refers to compression of one or more of the neurovascular structures. Thoracic outlet syndrome medical treatment guidelines. The syndrome occurs when a nerve or blood vessel is compressed by the rib, collarbone, or muscle. Manual techniques to reposition rib cage and decrease postural asymmetries. Exercises for thoracic outlet syndrome university health network. 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. Diagnosis and treatment of thoracic outlet syndrome rishi n. Exercise program used to strengthen and stretch muscles in the chest, shoulders and neck. Please consult your doctor or physiotherapist for specific thoracic outlet syndrome treatment.
Pdf thoracic outlet syndrome tos diagnosis and therapy. You will need to go through several tests to find out if tos is actually the cause of your pain. Thoracic outlet syndrome treatment exercises top 4. Thoracic outlet syndrome tos is a musculoskeletal condition that can affect the neurovascular supply to the arm by compressing one or more of the structures that pass through the thoracic outlet. Physical therapy to help restore normal posture, strengthen key muscles, and relieve compression in affected nerves. Jan 05, 2017 the term thoracic outlet syndrome tos was originally coined in 1956 by rm peet. What are the signs and symptoms of thoracic outlet syndrome.
Exercises for thoracic outlet syndrome read this pamphlet to learn more about. Before choosing any treatment, it is important to talk to your health care provider about the potential benefits, risks and side effects of your treatment options. Thoracic outlet syndrome tos is a challenging condition to diagnose correctly and manage appropriately. In many cases, the patient will be treated with thrombolytic medications and start. A common sequela of neck injuries, lippincott, philadelphia 1991. Diagnosis diagnosis is based on a combination of clinical symptoms and exam findings, including positive thoracic outlet orthopedic. In all types of tos, the thoracic outlet space is narrowed, and there is scar formation around the structures. Brittany bankson and learn three movements to help relieve and prevent pain and tightness associated with thoracic outlet. Thoracic outlet syndrome tos refers to a constellation of signs and symptoms that arise from compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle, within the confined space of the thoracic outlet. Please give this handout to your physical therapist. The massachusetts general hospital division of thoracic surgery provides comprehensive evaluation and treatment for patients with all forms of thoracic outlet syndrome tos, including neurogenic, venous and arterial.
Clinical integration of osteopathic manipulative medicine thoracic outlet syndrome author. The most common initial treatment for neurogenic thoracic outlet syndrome is physical therapy. These nerves supply motor movement and sensory feeling function to the arms and hand. Neurogenic thoracic outlet syndrome in whiplash injury. The symptoms of tos arise from compression of the brachial plexus. Learn about a possible cause of pain, numbness and tingling in your arms and hands. Thoracic outlet syndrome tos can cause pain and numbness in the shoulder, arm, and hand. Clinical integration of osteopathic manipulative medicine. Thoracic outlet syndrome is very controversial in the medical literature.
To reduce the risk of blood clots and pulmonary embolism, treatment for venous thoracic outlet syndrome may include thrombolytic clotbusting or anticoagulant blood thinning medications and surgery. Generally, passive and palliative interventions are viewed as a means to facilitate progress in an active rehabilitation program with concomitant attainment of objective functional gains. If you would like to discuss treatment with an experienced therapist at michigan medicine contact michigan medicine physical therapy at 7349367070. Exercises and stretches for thoracic outlet syndrome tos. Jun 03, 2018 treatment options for thoracic outlet syndrome can include one or more of the following. Thoracic outlet syndromes genetic and rare diseases. Heavy loads hung from the shoulders can really stress rib cage and spinal structures and cause thoracic outlet syndrome fig. Also, in some cases, your surgeon may conduct a procedure to remove a clot from the vein or artery or repair the vein or artery prior to thoracic outlet decompression.
If is important that your physical therapist has experience with thoracic outlet syndrome. Thoracic outlet syndrome surgery has risks of complications, such as injury to the brachial plexus. Commonly the distinction between vascular thoracic outlet syndrome vtos and neurogenic thoracic outlet ntos is made. The goal of stretching is to relieve compression in the thoracic cavity, reduce blood vessel and nerve impingement, and realign.
The goal of treatment for thoracic outlet syndrome is to ease symptoms and pain. Thoracic outlet syndrome prevention ergonomics plus. Despite many reports of operative and nonoperative interventions, rigorous scientific investigation. Thoracic outlet syndrome john broussard, do sports medicine fellow. Patients with symptoms from compression of the neurovascular bundle in the thoracic outlet are described as having thoracic outlet syndrome tos, which is best thought of as three conditions classified according to which structures are involved. Orthopedic tests page 3 of 26 for confirming the correct diagnosis, tainting the conclusion with incorporation bias. Thoracic outlet syndrome diagnosis and treatment mayo.
Thoracic outlet syndrome diagnosis and treatment mayo clinic. A protocol of treatment for the physical therapy management of the thoracic outlet syndrome has been established at amsterdam memorial hospital, amsterdam, new york. Thoracic outlet syndrome symptoms and causes mayo clinic. Treatment options for thoracic outlet syndrome can include one or more of the following. A group of syndromes in which biomechanical obstructions are believed to compress or obstruct structures in the thoracic outlet. Making the right diagnosis often takes time and can be a cause of. Thoracic outlet syndrome information page national. Surgical decompression for patients with tos has been shown to be both an efficient and. There are three categories of thoracic outlet syndrome. Thoracic outlet syndrome is a complex condition in which blood vessels andor nerves are entrapped or compressed as they exit the thorax. Information for patients who have been diagnosed with thoracic. Tos consists of a myriad of symptoms depending on compression of the neurovascular bundle of the upper limb as it passes through the thoracic outlet 11, 18, 22.
Sustained work postures such as forward head and arm positions can contribute to. 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 disorders differ, depending on the parts of the body they affect. This article will help you know what it is and how to treat it. Thoracic outlet compression is a disorder that is caused by compression of nerves in the brachial plexus nerves that pass into the arms from the neck and blood vessels. The national institute of neurological disorders and stroke ninds and other institutes at the national institutes of health support research in tos through grants to major medical research institutions across the country. Thoracic outlet syndrome is a term used for several different conditions that can occur when nerves andor blood vessels in the thoracic outlet are compressed or irritated. Stretching, occupational and physical therapy are common noninvasive approaches used in the treatment of tos.
Thoracic outlet syndrome most commonly affects the nerves, but the condition can also affect the veins and arteries least common type. Thoracic outlet syndrome exhibit page number 1 department of labor and employment division of workers compensation ccr 110 rule 17, exhibit 3 thoracic outlet syndrome medical treatment guidelines a. Pdf thoracic outlet syndrome, a group of diverse disorders, is a collection of symptoms in the shoulder and upper extremity area that results. The exact cause of tos is unknown, but there are situations that are more likely to squeeze the nerves, veins, or arteries in the thoracic outlet and cause tos. Also, surgery may not relieve your symptoms, and symptoms may recur. This narrow passageway is crowded with blood vessels, muscles, and nerves. Skeptics argue that the upper form or mixed form is more likely a separate condition and not caused by entrapment of the brachial plexus in the thoracic outlet.
Anterior scalene middle scalene posterior scalene brachial plexus clavicle first rib subclavian artery. The diagnosis and treatment of patients with thoracic outlet syndrome has been. This is the result of a number of factors including the multifaceted contribution to the syndrome, the limitations of current clinical diagnostic tests, the insufficient recognition of the subtypes of tos and the dearth of research into the optimal treatment approach. Tos is a relatively common disease, estimated to affect 8%. Outcomes after surgery for thoracic outlet syndrome. This protocol of treatment for the physical therapy management of the thoracic outlet syndrome was presented. Despite many reports of operative and nonoperative interventions, rigorous scientific investigation of this syndrome leading to evidencebased management is lacking. Treating thoracic outlet syndrome erik dalton blog. The correct diagnosis of thoracic outlet syndrome is critical as it can lead to chronic pain and limb dysfunction.
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