Date of Award


Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)


Physical Therapy

First Advisor

Schawnn Decker


Thoracic Outlet Syndrome -- rehabilitation; Thoracic Outlet Syndrome -- therapy; Case Reports


Background and Purpose: Thoracic outlet syndrome (TOS) is one of the most controversial clinical entities in medicine. It encompasses three related syndromes: compression of the brachial plexus (neurogenic TOS), compression of the subclavian artery or vein (vascular TOS), and a non-specific or disputed type of TOS.s Neurovascular compression may be observed most commonly in the interscalene triangle, but has also been described in the costoclavicular space and subcoracoid space.6 The purpose of this case study is to further explore the efficacy of manual therapy, specifically mobilization of the 1st rib, to relieve the symptoms of a 43 year old female, suffering from TOS.

Case Description: The patient is a 43 year old female presenting with a tingling sensation around her left scapula and down her left arm after prolonged periods of relaxed sitting. Myotomes, dermatomes and reflexes were all negative, bilaterally. Adson's maneuver and Roos test were both negative.

Intervention: Moist hot pack and IFC were administered for 10 minutes for muscle relaxation. The patient was then asked to lay supine and her first ribs were palpated. A manual depression of the first rib was performed and repeated three times. This treatment was repeated six times over the course of two weeks, in addition to a home exercise program.

Outcomes: The patient was seen three times per week for two and a half weeks for a total of eight treatment sessions. During the course of treatment, the patient reported a significant decrease in the frequency and severity of her symptoms. Once the therapist felt the patient had met her clinical goals, she was discharged with instructions to follow-up if any symptoms reoccurred.

Discussion: This case study demonstrates manual depression of the 1st rib as an easy, effective option in the conservative management of thoracic outlet syndrome.