THORACIC OUTLET SYNDROME DIAGNOSIS & TREATMENT

The neurogenic presentation is the most common. The syndrome is caused by compression or traction of one or more structures. Through a detailed clinical assessment, a clinical diagnosis is created and acted upon accordingly. Early manual treatment can be successfully used to treat neurogenic TOS. There is sometimes an indication for manual therapy where intermittent posture-related vascular compromise is seen but due to the possibility of serious consequences of vascular lesions, further investigation and consultant liaison is required prior to commencement of the manual treatment.

RELATED SPORTEX ARTICLES n Stapleton C. Arterial compression syndromes of the shoulder – Part 1. sportEX medicine 2009;39:22-26 n Stapleton C. Arterial compression syndromes of the shoulder – Part 2: Diagnostic arm manoeuvres. sportEX medicine 2009;40:22-26

References 1. Sanders RJ, Hammond SL. Venous Thoracic Outlet Syndrome. Hand Clinics 2004;20:113-118

2. Sanders RJ and Pearce WH. The treatment of thoracic outlet syndrome: A comparison of different operations. Journal of Vascular Surgery 1989;10:6:626-634 3. Sellke FW and Kelly TR. Thoracic outlet syndrome. The American Journal of Surgery 1988;156:4-57 4. Sanders RJ, Hammond SL, Rao BA. Pectoralis minor obstruction of the axillary vein: report of six patients. Journal of Vascular Surgery 2007;46:3:601-604 5. Oates SD and Daley RA Thoracic Outlet Syndrome. Hand Clinics 1996;12:705-718 6. Longley DG, Yedlicka JW, Molina EJ, Schwabacher S,Hunter DW and Letourneau JG. Thoracic outlet syndrome; evaluation of subclavian vessels by colour duplex sonography. AJR 1992;158:623-630 7. Gillard J, Perez Cousin M, Haculla E, Remy J, et al. (2001) Diagnosis thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology and helical computed tomography in 48 patients. Joint Bone Spine 2001;68:416-424. 8. Dorazio RA, Ezzet F. Arterial complications of Thoracic Outlet Syndrome. The American Journal of Surgery 1979;138:246-250 9. Patton GM. Arterial Thoracic Outlet Syndrome. Hand Clinics 2004;20:107-111 10. Telford E D, Mottershead S. Pressure at the cervico-brachial junction. An operative and anatomical study. Journal of Bone and Joint Surgery 1948;30:249-265 11. Webhe MA. Schle gel JM. Nerve gliding exercises for thoracic outlet syndrome. Hand Clinics 2004;20:1;51-55 12. Panegyres PK, Moore N, Gibson R, Rushworth G, Donaghy M. Brain

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1993;116:823-841 13.Walsh MT. Therapist management of thoracic outlet syndrome. Journal of Hand Therapy 1994;7:131-144 14.Thomas GI, Jones TW, Staton Staveney L, Manhas DR.The middle scalene muscle and its contribution to the thoracic outlet syndrome. American Journal of Surgery 1983;145:589-592 15. Demirbag D, Unlu E, Ozdemir F, Genchellac H, Temizoz O, et al . The relationship between magnetic resonance imaging findings an postural manoeuvre and physical examination tests in patients with thoracic outlet syndrome: results of a double-blind, controlled study Archives of Physical Medicine and Rehabilitation 2007;88:844-851 16. Takeshita M, Minamikawa H, Iwamoto H, Tagagishi N. International Orthopaedics 1991;15:1-5 17. Smith RA, Cummings JP. The axillary arch: anatomy and suggested clinical manifestations. Journal of Orthopaedic and Sports Physical Therapy 2006;36(6):425-429 18. Sanders RJ, Rao NM. Pectoralis minor obstruction of the axillary vein: reports of six patients. Journal of Vascular Surgery 2007;45:6:1206-1211 19. Huang J, Zager EL. Thoracic Outlet Syndrome. Neurosurgery 2004;55:4:897- 902

20. Crawford FA. Thoracic Outlet Syndrome. Surgical Clinics of North America

1980;60;4:947-956 21. Caparrelli D. Subclavian artery aneurysm secondary to cervical rib. Archives of Surgery 2006;141:514 22. Lain TM. The military brace syndrome Journal of Bone and Joint Surgery 1969;51A:557-560 23. Butler D. The sensitive nervous system. Noigroup Publications Australasia Pty Ltd 2000 24. Grant DS , Shaw PJ, Adiseshi M. Journal of the Royal Society of Medicine 1988;81:476-47825 25. Vanti C, Natalini L, Romeo A, Tosarelli D, Pillastrini PI. Conservative Treatment of Thoracic Outlet Syndrome. A review of the literature. Europa Medicophysica 2007;43(1):55-70 26. Lundborg G. Nerve injury and repair. Elselvier, Churchill Livingstone 2004 27. De Angelis LM, Posner JB. Neurologic complications of cancer. University Press, New York 2009 28. Leffert R and Cumley G. The relationship between the dead arm syndrome and thoracic outlet syndrome. Clinical Orthopaedics 1987;223:20-31 29. McGillicuddy JE. (2004) Cervical Radiculopathy, entrapment neuropathy and thoracic outlet syndrome: how to differentiate? Journal of Neurosurgery Spine 1 2004;2:179-187 30.Kremer RM, Ahlquist RE. Thoracic Outlet Compression. The American Journal of Surgery 1975;130(5):612-616

THE AUTHOR Teri Bayford (MSc, MCSP, HPC Registered) qualified as a physiotherapist in 1991. She has worked extensively in hospital, private practice and sporting settings within Zimbabwe. Early in her career she completed the well- respected, post-graduate, South African, Orthopaedic Manipulative Therapy training and since then she has gone on to successfully complete an MSc

in Orthopaedic Medicine. The modules of this include the Diploma of Injection Therapy and the Diploma in Orthopaedic Medicine Advanced Clinical Practice. Since coming to the UK in the late 1990s Teri has worked in a variety of NHS settings and since 2003 she has held an orthopaedic clinical specialist post in West Wiltshire. Her interest in thoracic outlet syndrome started following introduction to the syndrome during a post WCPT Africa conference in 1996. Since then, extensive study and hands on experience, gleaned from many facets of medicine, has enabled her to bring to the field of physiotherapy a comprehensive assessment and successful treatment approach.

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n Video overview of the structures involved in TOS utilising Primal Pictures’ Anatomy of the Shoulder and Anatomy of the Head and Neck.

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