THORACIC OUTLET SYNDROME

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Presentation transcript:

THORACIC OUTLET SYNDROME

Outcomes Be familiar with the anatomy and of the thoracic outlet. Be familiar with the clinical presentation of a patient with typical Thoracic Outlet Syndrome. Be familiar with the most widely used medical as well as physiotherapy treatment protocols for a patient with typical Thoracic Outlet Syndrome. Be able to give appropriate exercises and advice to a patient with typical Thoracic Outlet Syndrome.

Pathology The neurovascular structures run from the thorax to the upper extremities through the thoracic outlet Four specific areas: Superior thoracic outlet Scalene triangle Costo-clavicular area Pathway of the coracoid pectoralis

Symptoms Will depend on the specific structures – brachial plexus and the subclavical arteries Symptoms may be neurological, vascular or both Loss of: Stereognosis Fine co-ordination Clumsiness of the hands Patient complains of swollen hands/hands feel heavy and numb

Symptoms (cont) Fingers feel numb/cramps in fingers Vascular symptoms worsen with elevation of the shoulders and if a heavy object is carried Neurological symptoms: Nerve root pain Abnormal sensation Weakness Vascular symptoms: Ischaemic pain Claudication

Symptoms (cont) Symptoms may be aggravated by abduction of the arm Onset of symptoms usually spontaneous but can also follow after trauma to the arm or neck Neurological signs can be seen with the 3 minute stress test and vascular signs with abduction, extension and lateral rotation during palpation of the radial pulse

Symptoms (cont) Add rotation of the head Deep breathing A positive test shows signs of known pain, reduced pulses and pallor of the hands NB Remember ULTT

Treatment Conservative treatment except with neurological signs where surgery is indicated Handling of fear and ignorance Posture correction Exercises for the strengthening of the pectoral girdle Mobilisation of the1st rib, cervical as well as upper and mid thoracic Triggerpoints in m scaleni and m trapezius Relaxation exercises

Treatment (cont) Stretches of m scaleni and m pectoralis Advice regarding activities that provoke symptoms: Refrain from carrying heavy objects Refrain from wearing heavy jackets Do not let arm hang down while sleeping Always keep shoulder slightly elevated If there is no improvement – resection of the 1st rib or clavicle (cosmetically unacceptable)