Vaskulárna medicína 3-4/2017

Rehabilitation as part of conservative treatment of „thoracic outlet syndrome“ (case report)

Compression syndromes belong to vascular diseases and they can be largely chaaracterized by vascular symptomatology. Thoracic outlet syndrome (TOS) is very well defined. First reports on the compression syndrome in the literature have been recorded in the end of the 19th century. The incidence of the TOS varies between 3-80 cases of 1000 subjects. Neurogenic symptoms are mostly frequent. The proportion of arterial and venous symptoms is nearly equal. The compression of blood vessels and nerves is caused by the narrow space of the thoracic outlet and it is emphasized especially in certain movements of the arms and head. Congenital anomalies include excessive cervical rib and elongated transverse process of cervical vertebra very often can cause neurovacular compression. Symptomatology of TOS can be caused also by the hypotrophy or conversely hyperthrophy of shoulder girdle muscles. Excessive overloading of the upper extremities or even some kinds of sports or occupations may be causing this disease. Recently, most departments involved in the surgical treatment of TOS emphasize the role of comprehensive rehabilitation before surgery. Methodology.We present a case report of 51-years-old female with TOS left with combination of neurogenic and arterial type of symptomtology. We have introduced rehabilitative therapy and appropriate precautions in the conservative treatment of TOS with good result. Good cooperation between the physiotherapist and patient and patient´s compliance is very important. Physical therapy consists of correcting of the incorrect posture and incorrect analyzing movement patterns and muscle dysbalance. Physiotherapy must be designed individually based on clinical examination of the patient. Manual therapy, mobilization of clavicle, isometric relaxation and antigravity relaxation of pectoral and trapezius muscles, stretching, proper breathing drill, treating of trigger points in minor pectoral muscle can be complemented by the appropriate physical therapy. Conclusion.Rehabilitation therapy of the TOS can significantly help to improve the quality of life of the patient.

Keywords: thoracic outlet syndrome, compression syndromes, physiotherapy