Steemit Learning Challenge-S22W6: Physical Therapy Intervention: Thoracic Outlet Syndrome

Hello, everyone; we are here to share the contest for week 6 and final week, Steemit Learning Challenge season 22. I am grateful to all the users who participated in the previous week and supported my course, and thankful to the Steemit team for this opportunity. I invite all the users to share their unique participation and try to gain maximum grades to get selected as the winner of the Steemit Engagement Challenge season 22, week 6.

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Thoracic Outlet Syndrome (TOS)

Thoracic Outlet Syndrome is the compression of the nerves or vascular structures that passes or leave through or over the superior rim of thoracic cage. It's known by other names as well on the basis of site involve or neurovascular compression like First Thoracic Rib, Cervical Rib, Hyper abduction syndromes, costoclavicular.

The patient arrived with past medical history anatomic anomalies like of extra rib or unusual sternoclavicular and other reasons. The anatomical structures where this syndrome can occur are brachial plexus (nerves that control arm & hand functions), scalene muscles ( muscles around the neck region), subclavian artery & vein that supply blood to upper region like neck, shoulder and thoracic.

DD Book

Causes

The common causes of TOS are below:

• Occupational activities like overhead activities while carrying heavy load, repetitive arm movements.
• Poor posture for example sleeping with arms elevated overhead.
• Acute Trauma or injuries like whiplash injury that occur in RTA ( road traffic accident) due to hyperflexion or hyperextension of cervical region.
• It can also occur in some sport activities like in swimmers, volleyball, baseball etc.
• History of such injuries in past & occur again
• Compression of any structures that are around neck and shoulder region.

Symptoms

The common symptoms shown in TOS patients are categorized as vascular and neuropathic sign & symptoms.

Vascular

• Bluish hand appearance due to abnormal blood flow or supply to hand or arm especially in overhead activities.
• Cold & heaviness in arm & hands while performing exercises as blood supply compromised in extremities.
• Throbbing type pain in chest, neck, arm and hand.
• Puffiness or swelling sometimes in axilla, arm, clavicle, or hand region.
• Fatigue and weakness in the upper extremity

Neuropathic

• Tingling and numbness sensation in medial side or ulnar nerve distribution pattern.
• Muscle wasting or atrophy in hand, difficulty in performing the fine motor activities.
• Pain in the ulnar nerve distribution patter.

Types of Thoracic Outlet Syndrome

There are 3 types of TOS based on the structures involvement.

• Vascular TOS: this is the type in which vascular structures involved like subclavian artery and vein that comprised the blood supply to neck, arm and hand.
• Neurogenic TOS: this is the type in which nerves involve of brachial plexus like most commonly ulnar nerve and others too that causes tingling, numbness sensation in shoulder, axilla, arm and hand.
• Mixed TOS: this is the type in which neurovascular structures involved both nerves and blood vessels. Or combination of vascular and neurogenic type of TOS.

Diagnosis

TOS diagnosis can be made by different methods, but commonly used are:

• History taking about family, occupation, past medical, and surgical history.
• A thorough physical examination by a physician or physical therapist.
• X-ray, Ultrasound and MRI to assess arthritis, any tendon ruptures, and muscle damage, respectively.
• We will also perform EMG & NCS to assess the nerve damage and muscle strength.

Special Tests

In physiotherapy, we perform some special tests to confirm the diagnosis.

Adson & Halstead maneuver	Allen/Wright test

DD Book

1. Adson Maneuver
   • This is the test performed by patient in sitting position, arm at his/her side, face forward, measure the BP before performing test, the ask patient to turn head/neck, head and neck are in extended position. Ask patient to deep breath or hold the breath of symptoms reproduce then test is positive.
2. Halstead Maneuver
   • This is the test performed by patient in sitting position, measure the radial pulse before test, making the above test position just rotates head to opposite side, the therapist applies a downward and traction force site involved. Assess the radial pulse if there is change in rhythm then vascular TOS is positive.
3. Allen or Weight Test
   • This test is performed on patient in sitting position, hyperabduction at shoulder joint. Observe the changes in skin color, temperate, also radial pulse to see any changes in rhythm.

Physical Therapy Intervention for Thoracic Outlet Syndrome

Physical therapy interventions for Thoracic Outlet Syndrome for days to weeks to regain normal range of motion or performing activities of daily living, and subside the symptoms. Here are a few exercise videos that you have to perform to treat Thoracic Outlet Syndrome patients. Treatment protocols vary from patient to patient.

But the main thing is you have to evaluate the exact cause of a Thoracic Outlet Syndrome and its stage types as well because treatment protocol varies from stage to stage, whether it's due to overuse or trauma. We can treat this condition completely with physical therapy, but sometimes surgical intervention is required if further damage occurs to spine.