Thoracic Outlet Syndrome (TOS) is characterized by upper extremity pain or paresthesia caused from occlusion, compression, injury, or irritation to the neurovascular structures traversing the thoracic outlet. The clinical presentation for TOS can be very similar to that of cervical radiculopathy.
Check out the attached video where I describe a useful maneuver that helps differentiate cervical radiculopathy from TOS:
In the absence of acute or threatening neurovascular problems, conservative care should be the treatment of choice for TOS. The management pathway for TOS is based upon the specific site(s) of neurovascular compression, and clinicians should keep in mind that TOS is often multifactoral in origin and successful management needs to address each component.
Manipulation, myofascial release, stretching, and nerve mobilization are generally indicated for TOS patients. Nerve mobilization, particularly for the ulnar nerve, will likely play a role in recovery.
Lifestyle modifications may include: avoidance of repetitive postural stress and workstation modification. Patients should avoid carrying heavy loads, especially on their shoulder i.e. carpet rolls. Briefcases, laptop cases or heavy shoulder bags should be lightened. Bra straps may need additional padding or consideration of replacement with a sports bra.
Check out this ChiroUp Lay Condition Report that provides your patients with a clear description of TOS, including appropriate ADL’s and exercises- created and delivered in less than 20 seconds!
About the Author
Dr. Brandon Steele
Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.
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