By Megan Plante, DPT
22 May, 2014
Clinical Case of the Week
cervical, clavicle, clinical presentation, complicated, peck minor, Ribs, scalenes, Thoracic outlet syndrome, TOS
Recently, I have had 3 physical therapy patients in the clinic with a complicated clinical presentation. All 3 patients have a different cluster of symptoms and impairments. What they each have in common is that they have upper extremity symptoms that are not of cervical spine (radiculopathy) origin. Instead, their pathology is a result of tight chest and neck musculature, compressing the bundle of nerves that control the movement and sensation of the arm. Clinically, this is known as Thoracic Outlet Syndrome, or, TOS.
What is Thoracic Outlet Syndrome?
- Compression of the artery, vein and/or nerves that pass through the thoracic outlet.
- There are 3 possible locations for the compression to occur:
- In between your scalene (neck muscles)
- In between the clavicle and first rib
- Under the peck minor (chest muscle)
| The most common compression is of the nerves. This results in vague pain of the arm as well as various sensations: itchy, hot, cold, pins and needles, etc.It may be painful to the touch for any of the muscles involved with the compression.
Poor posture as well as decreased flexibility of the thoracic spine are also associated with TOS.
Rarely, an extra rib (cervical rib) is the cause. |
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Physical Therapy Treatment for TOS
- Physical therapy is the first line of treatment for Thoracic Outlet Syndrome (TOS).
- A therapist will teach you how to stretch what needs to be lengthened as well as how to strengthen muscles that will improve posture.
- Physical therapists also have manual techniques to help you progress your treatment
- Most people diagnosed with TOS have a good prognosis and will have complete resolution of symptoms with conservative treatment only.
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By Nick Rinard Physical Therapy
14 Mar, 2014
Clinical Case of the Week
ankle pain, clinical presentation, Nick Rinard, Nick Rinard physical therapy, pain-free, Physical Therapy, Portland Oregon, relationship, results, Spine, treatment
By MiKayla Sanocki, SPT
Did you know a back problem can cause symptoms such as pain, decreased strength and decreased sensations into the thigh, calf, ankle or foot? Physical therapists trained in Mechanical Diagnosis and Therapy (MDT) here at Nick Rinard Physical Therapy can determine during the evaluation if any of these lower leg symptoms are coming from your back.
Check out this bizarre clinical presentation we treated at Nick Rinard Physical Therapy:
She did not remember any trauma to the ankle
The patient came to physical therapy for an “ankle sprain” that occurred 3-months earlier. She stated she woke up unable to put any weight on her right foot. The pain had remained constant in her ankle, so bad at times that she couldn’t walk! Upon further questioning, the patient revealed what she had been doing the day before: She had driven 2 hours, on her way home from helping clean a house. During the drive she had discomfort in her buttock and hamstring that made her want to pull the car over to stretch. She did not remember any trauma to the ankle, however, but the ankle pain was the only pain she was experiencing now.
Her ankle pain has caused her to quit running and yoga — two of her favorite activities.
Mechanical Evaluation finds cause in spine
During the mechanical evaluation we found that certain directions of low back movements decreased the pain in her ankle. After being sent home with 1 simple exercise to perform every waking hour – which she did perfectly – she returned within 24 hours reporting 90% recovery in pain! Over the next week we were able to progress her exercises and now the patient reports no ankle pain at all. In only 4 visits we were able to abolish her ankle pain, and she is now getting back to running and yoga!
The patient reports, “I now have the tools to prevent the return of my back and ankle pain”.
Treatment at Nick Rinard Physical Therapy vs Traditional PT
In contrast to MDT, traditional PT would not have uncovered the spinal cause of the patient’s ankle pain. Treatment would have been ineffective since it would have focused only on trying to treat the symptom.
Do you know if your pain in the legs or arms could be coming from the spine? Come see us at Nick Rinard Physical Therapy and find out!
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