N Am J Sports Phys Ther. 2009 Nov;4(4):170-81.
Bilateral functional thoracic outlet syndrome in a collegiate football player.
North American journal of sports physical therapy : NAJSPT
Jason H Robey, Kyndall L Boyle
PMID: 21509101
PMCID: PMC2953353
Abstract
BACKGROUND: Thoracic Outlet Syndrome (TOS) involves compression of the brachial plexus, subclavius artery and vein. Many studies discuss efficacy of surgery and few discuss conservative treatment. It is unknown what specific forms of conservative treatment are best.
OBJECTIVE: Describe conservative management for TOS using unique exercises.
CASE DESCRIPTION: A collegiate football player reported numbness/tingling down his right arm after a right brachial plexus stretch injury. Seven months later, he was diagnosed with recurrent cervical traction neuropraxia. Two months later, he reported bilateral symptoms and was diagnosed with functional TOS. The athlete began shoulder strengthening (deltoid, middle trapezius, rhomboids, pectoralis major, latissimus dorsi, biceps, upper trapezius and rotator cuff) and stretching (pectoralis, scalene and upper trapezius) which failed to resolve his symptoms after four weeks. Surgical resection of bilateral first ribs and quitting football was recommended by four physicians. Unique therapeutic exercises developed by the Postural Restoration Instituteā¢ were used to optimize respiration/posture via muscle activation and inhibition. After six weeks, the athlete was asymptomatic and returned to football but still experienced paresthesia with contact. Additional exercises were prescribed and remaining symptoms were abolished.
OUTCOMES: The Northwick Park Neck Pain Questionnaire was 55.5% at initial and 0% at four weeks and discharge.
DISCUSSION: Athlete did not demonstrate relief of symptoms from shoulder stretching and strengthening. Intervention designed to optimize respiration/posture by repositioning the pelvis/trunk via specific muscle inhibition and activation resulted in abolishing the athlete's symptoms. Management that aims to optimize respiration via muscle inhibition, activation, and repositioning warrants further research.
References
- J Hand Ther. 1994 Apr-Jun;7(2):131-44 - PubMed
- Knee Surg Sports Traumatol Arthrosc. 2001 Sep;9(5):290-5 - PubMed
- Orthop Clin North Am. 1975 Apr;6(2):507-19 - PubMed
- J Tradit Chin Med. 1999 Sep;19(3):218-20 - PubMed
- Physiother Theory Pract. 2009 Jan-Feb;25(1):44-54 - PubMed
- J Hand Surg Br. 1995 Feb;20(1):34-9 - PubMed
- Br J Rheumatol. 1994 May;33(5):469-74 - PubMed
- Spine (Phila Pa 1976). 2006 Jun 1;31(13):1467-72 - PubMed
- Eura Medicophys. 2007 Mar;43(1):55-70 - PubMed
- Am J Surg. 1993 Feb;165(2):282-4 - PubMed
- Med Sci Sports Exerc. 1998 May;30(5):665-70 - PubMed
- Aust J Physiother. 1989;35(4):227-38 - PubMed
- J Physiol. 1997 Dec 1;505 ( Pt 2):539-48 - PubMed
- Clin Chest Med. 1988 Jun;9(2):175-93 - PubMed
- Semin Thorac Cardiovasc Surg. 1996 Apr;8(2):201-7 - PubMed
- BMJ. 2005 Jan 8;330(7482):75 - PubMed
- J Am Acad Orthop Surg. 1994 Nov;2(6):317-325 - PubMed
- Rev Med Interne. 1999 Sep;20 Suppl 5:500S-505S - PubMed
- Proc (Bayl Univ Med Cent). 2007 Apr;20(2):125-35 - PubMed
- Am J Respir Crit Care Med. 1999 Mar;159(3):796-805 - PubMed
- Eur J Cardiothorac Surg. 1999 Jul;16(1):44-7 - PubMed
- Proc Staff Meet Mayo Clin. 1956 May 2;31(9):281-7 - PubMed
- J Physiol. 2001 Dec 15;537(Pt 3):999-1008 - PubMed
- Hand Clin. 2004 Feb;20(1):43-9, vi - PubMed
- Explore (NY). 2005 Sep;1(5):377-9 - PubMed
- Am J Respir Crit Care Med. 1999 Jan;159(1):179-87 - PubMed
- J Hand Surg Am. 1995 Jul;20(4):542-8 - PubMed
- Arch Phys Med Rehabil. 1997 Apr;78(4):373-8 - PubMed
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