Thoracic Outlet Syndrome The Coraco-Pectoral Loop Environmental Stress Reinforcers Culture Behavioral Sick Role somatization Biological Genetics Physiology Psychological Emotional deficit Cog. Tendency Psychopathology 1
Symptom Assessment Empathetic connection between you and the client. Development of trust and confidence in the process. Listen carefully to the client prior to planning intervention TOS: True Neurogenic Presentation Paraesthesia typically along the C8-T1 distribution. Atrophy of the ulnar intrinsic muscles. Weakness and incoordination. Positive Supraclavicular Tinel s sign. 2
Disputed TOS: Symptom Presentation Chronic upper extremity pain that does not occurs in typical dermatome or peripheral nerve innervation patterns. Transient cramping, stiffness weakness and muscle fatigue can accompany the pain however; these symptoms are inconsistent and can present in non-anatomic patterns. Costo-Clavicular Syndrome Narrowing of space between the clavicle and the first rib. Can lead to either vascular or neurogenic symptoms. Postural change is depressed and retracted scapula. Muscle and ligament considerations. Costo-Clavicular Syndrome 3
Clavicle Concerns Costo-Clavicular Syndrome Costo-Clavicular Syndrome 4
Pectoralis Minor Syndrome Symptoms are primarily neurological. Vascular symptoms are unusual in this zone. Compression is between the anterior aspect of the ribs and the Pectoralis Minor. Unstable humeral head can cause compression in this area Pectoralis Minor Syndrome Brachial Plexus/Pec. Minor 5
6
Shoulder/Anterior View Pectoralis Minor Syndrome Highly associated with: Postural changes Poor work habits or provocative positions Shoulder pathology Pectoralis Minor Syndrome Clinical Findings: Poor standing/sitting posture. Positive Wright s/roo s tests. Asymmetry of the SC/AC joints Vascular changes in the hyperabduted positions 7
Postural Concerns Postural Concerns Tight pectoralis minor. Weakness of any of the following muscles: Trapezius Levator Scapula Rhomboids Serratus Anterior Pectoralis Minor 8
Trapezius Levator Scapula Rhomboids 9
Serratus Anterior Scapula Force Couple Scapula Mobility 10
ASSESSMENT Scapula Assessment Scapula Depression/Long Neck Presentation Outwardly rotated scapula Inwardly rotated scapula Scapula in Neutral 11
Scapula Assessment Clinical Presentation Releasers: Less symptoms during the day. Symptoms increase sharply at night Compressors: Increased symptoms with overhead work Scapula Release Test 12
Scapula Release Alternate Position Roo s/east Test Wright s Hyperabduction 13
Supraclavicular Palpation 40 Costoclavicular Test 41 Pec. Minor Tightness Assessment 14
Anterior Tipping Forward Head Posture Long Neck/Anterior Tipping 15
Trigger Point Assessment Travell Levator Scapula Pattern Rhomboid Pattern 16
Pectoralis Minor Pattern Treatment Planning What makes sense? What are your observations? What is the overall goal? Emphasis on patient education and participation. Focus on one problem at a time. Treatment Approaches Acute, irritable disorder: (intense, continuous symptoms). Correct resting position for sleep and sitting. Address breathing issues. Gentile, active scapulae retraction exercises. Positional postural exercises. 17
Rest Positions/Releasers 53 54 18
Treatment Approaches Sub-acute/moderately irritable disorder: Continue resting positions. Progress flexibility program. Begin strengthening program. Scapula Interventions Pectoralis Minor stretching. Periscapular strengthening Taping McConnell Kinesiotaping Stretching Program Active to begin with. Symptom free ranges. Low level postures. 19
Manual Stretching Pec. Minor 59 60 20
61 PNF Pattern ER PNF Pattern IR 21
Scapula Stabilization Ergonomic Training/Compressors Mild Symptoms Asymptomatic. Add PRE program. Address general conditioning. Maintain cervical/shoulder girdle length gains. 22
Thanks for Listening! Questions? 23