http://sciencelinks.jp/j-east/articl...07A0140632.php

;Conservative treatment, including therapeutic exercise, is the first choice of treatment for thoracic outlet syndrome (TOS). This often causes temporary worsening of symptoms. However, such symptoms have never been described. The authors report aggravation of symptoms during therapeutic exercise. Eighteen patients were examined including 12 who were examined retrospectively and 6 who had still being in therapy. There were 2 men and 16 women, aged 9 to 58 years old (mean 30 years old); 12 cases affected the right side, 1 the left side, and 5 were bilateral. Eight cases had non-traumatic TOS, and 10 had traumatic TOS. As therapeutic exercise, extension exercises of neck and scapular muscles and strengthening of muscle power were performed, and the aggravation of symptoms was examined. Eventually, all 18 cases (100%) completely resolved. However, temporary worsening of symptoms occurred in 17 cases (94.4%). Aggravated symptoms consisted of numbness of the upper extremity in 12 cases (66.7%), shoulder stiffness in 10 (55.6%), neck pain in 6 (33.3%), decreased muscle power in 6, autonomic dysfunction in 4 (22.2%), scalene pain in 2 (11.1 %), lumbago in 2 and muscle pain surrounding scapula in 2. The purpose of therapeutic exercise for TOS is removal of constriction factors of nerves and promotion of nerve gliding, and achievement of functional position by muscle strengthening. Therefore, it is difficult to avoid temporary aggravation of symptoms, which is produced by compression or stretching of nerves. It is important to explain the possibility of worsening of symptoms to the patient before treatment and adjust the amount of muscle exercise accordingly. (author abst.)


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