Date of Award

5-2021

Document Type

Thesis

Department

Physical Therapy

First Advisor

David Relling

Keywords

Thoracic outlet syndrome, thoracic outlet decompression, neurogenic, treatment, rehabilitation, therapeutic exercise

Abstract

Background and Purpose: Thoracic outlet syndrome (TOS) includes the signs and symptoms in the upper extremity caused by a compression of the brachial plexus, subclavian vein and/or subclavian artery at the thoracic outlet. The thoracic outlet symptoms may present as pain, weakness, numbness, tingling, and early fatigue or heaviness of the arm. Severe and unrelenting symptoms may lead to individuals considering surgical treatment. The purpose of this case report is to present an evidence based strengthening and stretching program for the post-operative care of TOS.

Case Description: This article describes the 10 - week outpatient physical therapy treatment of a 41-year-old female who underwent a thoracic outlet decompression of the left shoulder. The patient presented to therapy with decreased strength, decreased ROM, muscle imbalance, numbness of forearm on radial and ulnar sides anteriorly and in the hand.

Intervention: The interventions included therapeutic exercise for stretching and strengthening, range of motion, soft tissue mobilizations, and Kinesiotape.

Outcomes: With physical therapy intervention, the patient achieved increased active range of motion, increased strength, decreased pain, and improved postural awareness and alignment. The patient reported elimination of numbness in the fingers following surgery and numbness ceased in the forearm throughout physical therapy treatment. The patient’s Shoulder Pain and Disability Index (SPADI) score improved by 20% throughout her time in physical therapy.

Discussion: Rationale for treatment was based on recent studies for biomechanical and exercise considerations for shoulder dysfunction to help improve the patient’s presenting symptoms upon evaluation. Treatment changes were based on how the patient tolerated and responded to the treatment.

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