Thoracic Outlet Syndrome

Question 1

3 Compression sites for TOS

Answer 1

Scalenes.
1st rib
Pec minor

Question 2

TOS pathology

Answer 2

Sx. are due to a compression of the brachial plexus, blood vessels, and nerves by structures in the thoracic outlet region.
BP may stretch if arm is held in a fully elevated position.
Contributing factors: laxity in the sh, postural variations, respirtory patterns.

Question 3

TOS Clinical signs

Answer 3

Largely neurological cases, more femals then males.
Intermittent BP and vascular sx. of pain, paresthesia, numbness and tingling (ring and little) weakness, discoloration, and swelling.
Muscle length imbalances with tightness in anterior and weakness in posterior structures.
Faulty posture, poor endurance, and postural muscles, shallow respiratory pattern.
Pt. complains of difficulty sleeping, inability to hold weighted objects on affected side. Inability to maintain overhead positions or desk work.

Question 4

TOS interventions

Answer 4

Mobility of tight structures (anterior muscles, scalene, and pecs).
Massage x5 min on trigger points.
Increase strength and endurance of weak muscles.
Nerve gliding (flossing).
Respiration trainging (diaphramatic breathing)
Adapit activities: driving, purse on sh., bra straps, watch pts. at work.
Safe sleeping positions that avoid stress on nerves.
Use modalities to manage muscles spasm tension.

Question 5

Differences between brachial plexopathy and TOS

Answer 5

BP is usually due to trauma.
BP results in chronic pain.
BP pts. are less likely to have a better outcome than TOS pts.
BP symptoms indicate inflammation around the nerve root, bp, and other sites- multiple crush.
BP may take 24-36 hrs. to calm down once exacerbated.

Question 6

TOS exercises

Answer 6

Scapular retraction
Stretch the scalenes: chin tuck, straighten neck, side bend away, rotate towards.
Suboccuipital stretch: support neck and tuck the chin.
Pec stretch
Scapular clock
Modified superman (dont move out of frontal plane)