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Member
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Join Date: Aug 2006
Location: southern Calif
Posts: 221
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Member
Join Date: Aug 2006
Location: southern Calif
Posts: 221
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PT
Here is what he says about PT
Thoracic Outlet Syndrome Physical Therapy
Physical therapy (PT) is an important part of treating TOS. It’s best to work with a physical therapist who has experience treating TOS. When done correctly, physical therapy may improve TOS symptoms enough that more invasive therapy is not necessary. If surgery becomes necessary physical therapy improves outcomes after surgery.
Conservative management of TOS with physical therapy begins with a comprehensive assessment. A physical therapist’s assessment will include tests that, when used with medical diagnostic tests, can contribute to a more accurate diagnosis of TOS.
A specific TOS evaluation focuses on the following:- history of symptoms including mechanism of injury if applicable,
- static posture and dynamic posture,
- joint play of cervical and thoracic spine,
- 1st and 2nd rib mobility,
- clavicle and shoulder mobility,
- over used and/or underused muscles, and
- upper limb neurodynamic tests.
Specific tests for TOS used by physical therapists are Adson’s test, stress abduction test, postural positioning tests, supraclavicular test and costoclavicular test. 90% of patients with TOS have tenderness over the scalene muscles and can have their symptoms reproduced with the stress abduction test.
Each patient with TOS has different signs, symptoms, and causes of the syndrome. Physical therapy should address individual differences. It is very important that the treatment administered does not worsen nerve symptoms at any time throughout the rehabilitation. It is also very important that the patient take an active role in continuing their care with a home exercise program in addition to clinical treatment.
Physical therapy for TOS can be divided into three phases.
Phase 1 – Managing Acute Symptoms
During the first phase of physical therapy, the therapist concentrates relieving the acute or severe symptoms of the syndrome. He or she may educate the patient about the anatomy involved in TOS and the purpose of the techniques he or she is using to treat the symptoms.
The physical therapist may use ice to control swelling and manual techniques to relieve swelling. He or she may position your arm for comfort and may use a shoulder immobilizer until pain is reduced. The physical therapist will guide you through passive range of motion (PROM) exercises, active assisted range of motion (AAROM) exercises, and active range of motion exercises (AROM) of your spine, shoulder, and joints.
To control nerve pain, the physical therapist may use ice, positioning and desensitization techniques such as vibration, brushing, or touching with various textures.
During phase one, the physical therapist will address bony or soft tissue restrictions as tolerated by patient and educate the patient about neutral joint positioning. The physical therapist will begin stabilizing muscles, as well.
Phase 2 – Pain Stabilized
During phase two, the physical therapist will introduce more exercises for stabilization and neutral positioning. He or she may introduce neural mobilization techniques of specific nerves and will continue to work on joint and/or soft tissue dysfunction with manual techniques.
By the end of phase 2, the patient should be able to control cervical, thoracic, lumbar and scapular neutral positions in sitting, standing, supine/prone and side-lying.
Phase 3 – Progressing to function
During phase three, the patient will progress to functional movement slowly, with a focus on actively controlling neutral positions before adding weight.
TThe physical therapist will make recommendations about ergonomics and working. He or she will add resistance to exercises so that muscles can be strengthened. The patient and physical therapist work on continuing to progress to increased function and activities.
Next Steps
If, at the end of six to eight weeks of physical therapy, no significant progress has been made, the patient should be referred back to the physician or specialist for re-evaluation. If conservative physical therapy fails, the patient may undergo surgery or be referred to a chronic pain management program.
If surgery becomes necessary, physical therapy improves outcomes after surgery. After surgery, however, the emphasis is placed on maintaining freedom of the plexus to minimize scar tissue.
Overview | Causes of TOS | Signs and Symptoms | Getting Help | Diagnosing TOS
Medications | Complementary | Physical Therapy | Psychology | Surgery
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