Welcome to the physiogain community, & here we are going to discuss a very interesting topic called thoracic outlet syndrome exercises.
But before jumping onto the thoracic outlet syndrome exercises part, we first need to know what is thoracic outlet syndrome.
To understand this syndrome, we need to know what is a thoracic outlet.
So, let’s start with the anatomy of the thoracic outlet.
Thoracic outlet syndrome icd 10 code
G54.0 Brachial Plexus disorders
Overview/anatomy of thoracic outlet
The thoracic outlet can be defined as the space between the clavicle, the first rib, & the scalene muscles.
The thoracic outlet region is located around the lower part of the neck.
It begins just above & behind the clavicle & then extends to the upper part of the arm.
What is thoracic outlet syndrome?
This syndrome can be defined as the group of disorders that occurs when there is entrapment of the neurovascular bundle comprising the brachial plexus, subclavian artery & subclavian vein, neurogenic or vascular types (venous & arterial).
we will also be talking about thoracic outlet syndrome exercises, later in this article.
Depending on the primary structure compressed, they have different symptomatology & management.
- In this case, young and middle-aged adults are most commonly affected.
- This syndrome occurs in females & males in a ratio of 3:1.
- This can be a result of poor posture or post-trauma.
- The incidence of this problem increases with participation in sports.
Sites for compression (brachial plexus)
- Scalene triangle
- Cervical rib/first rib
- Pectoralis minor
- Costoclavicular space
- Unstable humeral head in an anterior/inferior position
Compression of most common to least common
Brachial plexus – subclavian artery – subclavian vein
Usually, when the thoracic outlet syndrome involves the subclavian vein & artery, then it requires immediate medical attention and is often the result of trauma or clot.
Possible contributing causes
Poor posture
It is one of the common causes of this syndrome, like as cases of forwarding rounded posture, and military/retracted posture.
Occupational
In this case, prolonged sitting position like in a computer work job can lead to this syndrome.
Those postures that require overhead activities like electrician or musician, lead to this syndrome.
Trauma
Trauma can easily lead to this syndrome, eg. Whiplash injury, instability of the shoulder, or clavicular fracture.
Overhead throwing sports such as volleyball, swimming, & baseball.
On carrying a backpack or heavy bag on one shoulder respectively.
Clinical findings
- A person may experience intermittent numbness & tingle in the forearm, wrist & hand.
- Most often in the medial forearm & hand in the distribution of C8/T1 nerve roots but can be the whole hand.
- There may be a feeling of weakness & fatigue in the upper extremity, especially with the arm overhead.
- Pain in the neck, arm, shoulder, & upper back.
- Pain will aggravate by overhead activities, & activities that depress the shoulder girdle.
- Pain gets worse at night.
- Pain gets better with rest.
- When you assess the patient, then postural examination may reveal low lying shoulder girdle on the affected side, forward head carriage & anteriorly rounded shoulder.
Impairments
- You can see the scapula depressed and downwardly rotated at rest.
- During the abduction and flexion of the glenohumeral joint, you may notice the late and insufficient upward rotation of the scapula
- In this case, there is restricted shoulder abduction which makes it hard to perform reaching activities.
- There is a decrease in the concentric strength of periscapular musculature.
- There is a decrease in eccentric control of periscapular musculature during adduction from full abduction of the shoulder.
- You may notice that the head of the humerus is in an anterior position.
- There is a substitution of the shoulder abduction with the recruitment of levator scapulae for shoulder flexion greater than 120 degrees+.
Physical therapy Intervention/treatment for thoracic outlet syndrome
Postural training – scapula setting exercises and postural awareness activities
- In this case, sit straight with your elbows by your side.
- Squeeze your lower border of the scapular down and together.
- You should be able to feel this contraction at the base of your shoulder blades.
- Hold for 5 seconds and then repeat 5 times.
- Perform this exercise at least 5 times a day.
we can do the Kinesio taping of the patient’s shoulder girdle.
The axillary sling assists in the upward rotation of the scapula.
we need to strengthen the periscapular musculature, focusing on the trapezius and serratus anterior.
Serratus Anterior
- Dynamic hug
Dynamic Hug
Lower Trapezius
- Prone external rotation at 90 degrees abduction
Prone External Rotation at 90 Degrees Abduction
Middle Trapezius
- Prone row
Prone Row
upper trapezius
- Shoulder shrug
Thera-band punch exercises
open- and closed-chain shoulder stabilization exercises
Seated row exercise, latissimus dorsi isotonic strengthening exercises
we need to do the recruitment training for the upward rotators of the scapular, serratus anterior, and upper trapezius.
Flexibility exercises: pectoral and scalene musculature
scalene stretch
Begin this exercise by placing one hand on the opposite part of the head and then laterally flexing the head.
while doing lateral flexion, tile the head slightly backward (move the neck back).
Chin tuck
In this case, Pull your chin back like you are trying to make a double chin.
Hold it for 5 seconds and then relax.
correct your workplace ergonomics and remove the precipitating factors
if glenohumeral instability is present, posterior glide to correct anteriorly located head of the humerus, and inferior glide for improvement in shoulder abduction and flexion
If you have any queries or suggestions regarding this article, please let me know in the comments below.