Current Clinical Concepts: Rehabilitation of Thoracic Outlet Syndrome

Abstract

Thoracic outlet syndrome (TOS) involves inconsistent symptoms, presenting a challenge for medical providers to diagnose and treat. Thoracic outlet syndrome is defined as a compression injury to the brachial plexus, subclavian artery or vein, or axillary artery or vein occurring between the cervical spine and upper extremity. Three common subcategories are now used for clinical diagnosis: neurogenic, arterial, and venous. Postural position and repetitive motions such as throwing, weightlifting, and manual labor can lead to symptoms. Generally, TOS is considered a diagnosis of exclusion for athletes due to the poor accuracy of clinical testing, including sensitivity and specificity. Thus, determining a definitive diagnosis and reporting injury is difficult. Current literature suggests there is not a gold standard diagnostic test. Rehabilitation has been shown to be a vital component in the recovery process for neurogenic TOS and for arterial TOS and venous TOS in postoperative situations.

Keywords: TOS; arterial; neurogenic.

Figure 1

Strength of recommendation taxonomy.

Figure 2

Anatomy of the thoracic outlet., From Illig KA, Donahue D, Duncan A, et al. Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. J Vasc Surg. 2016;64(3):e23–e35, used with permission of Mayo Foundation for Medical Education and Research, all rights reserved.

Figure 3

Exercises for rehabilitation phase 1: scapular position at rest. A, Scapula setting in standing or sitting. B, Scapula setting in prone. Scapula retraction with external rotation.

Figure 4

Exercises for rehabilitation phase 2: scapula control <30° of abduction. A, Bilateral prone extension. B, Unilateral prone or bent over extension. C, Unilateral prone or bent over row. D, Elastic-band W or robbers.

Figure 5

Exercises for rehabilitation phase 3: scapula control 45°–90° of abduction. A, Bilateral prone W. B, Bilateral prone T: horizontal abduction. C, Unilateral prone T: horizontal abduction. D, Unilateral prone row with external rotation.

Figure 6

Exercises for rehabilitation phase 4: scapula control in flexion. A, High to low row. B, Elastic-band extension. C, Scaption lift to 90°. D, Quadruped serratus protraction. E, Serratus press in supine or standing.

Figure 7

Exercises for rehabilitation phase 5: scapula control >90° of elevation. A, Unilateral prone Y-scapular–plane elevation. B, Elastic-band external rotation at 90°. C, Serratus wall slide. D, Landmine press.

Figure 8

Axillary taping technique.