Rehabilitation in Overhead Athletes With Thoracic Outlet Syndrome

Abstract

Thoracic outlet syndrome (TOS) is a clinical diagnosis resulting from the impingement of neurovascular structures between the clavicle and first rib. Effective prevention and nonoperative treatment in high-performance athletes with TOS are not well documented. The objective of reporting this case was to discuss the symptom progression, relevant clinical findings, and rehabilitation of an overhead athlete with diagnosed neurogenic TOS. Numerous rehabilitative techniques may be used to treat an athlete with TOS, with an emphasis on restoring full shoulder mobility, motor control, and normalized scapular mechanics in a throwing athlete, as well as improving functional thoracic range of motion. Modalities such as neuromuscular electrical stimulation and targeted muscle exercises are incorporated in the process. In the case presented, a collegiate-level throwing athlete returned to full participation at her previous level of play within 18 weeks of rehabilitation initiation. This report details the clinical findings and treatment options available to address pathology in an overhead athlete with a diagnosis of TOS. The clinical case example shows techniques that may help guide the clinician in establishing effective nonoperative or postoperative treatments for TOS.

Level of evidence: Level V, expert opinion.

Fig 1

Manual stabilization of lateral border of scapula for passive range-of-motion measurements.

Fig 2

Scapular and thoracic positioning with active shoulder flexion in patient’s sophomore year (A), junior year (B), and senior year (C) of college.

Fig 3

Progress of dynamometer testing on re-evaluation dates of treatment.

Fig 4

Infographic with treatment recommendations for thoracic outlet syndrome (TOS).

Fig 5

(A) Supine scapular retraction in T with cervical flexion. (B) Supine scaption (i.e., scapular-plane elevation) with TheraBand and cervical flexion. (C) Active thoracic flexion.