Hi friends, after reading around I am interested in participating in an amazing challenge this week. The challenge is titled: "Thoracic Outlet Syndrome" by @ashkhan following the contest link.
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| Previously I also invited other friends such as @ulfatulrahmah, Mr @muzack1 , and Mr @pelon53. |
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In this lesson we were given some tasks to complete, here are some questions and answers from me:
What's a thoracic outlet syndrome? Write in your own words after getting knowledge from the lesson post. (Note:don't add special tests or investigations and detailed treatment in this question. Write the answer precisely).
Dear friends, first we will reiterate a little what is Thoracic Outlet Syndrome? A condition in which compression of nerves or vascular structures passing through or exiting around the upper edge of the thoracic cavity is known as Thoracic Outlet Syndrome. The syndrome also has several other names which are all differentiated depending on the location involved or the neurovascular compression for example in Hyperabduction, First Thoracic Rib, Cervical Rib, and Costoclavicular syndromes.
Most commonly, patients present with an unfavorable medical history such as sternoclavicular or extra ribs which are unusual and several other reasons. As for the anatomical structure where the syndrome can generally occur due to the nerves that control the function of the arms & hands or called the brachial plexus, also because of the muscles around the neck area or often called the scalenus muscle, subclavian arteries & veins that supply blood to the upper part of our body for example to the shoulders, neck, and also the thorax.
As for the causes that make TOS occur, there are certainly many, but in general the causes are such as: due to a person's work activities, for example a person's activity carrying heavy loads over his head, and also because of activities that require a lot of repetitive arm movements, besides that poor posture is also one of the causes, it could be because of the way of sleeping with his hands raised above his head, not only that acute trauma or injury is also one of the causes of TOS, there are also causes of TOS due to a history of injuries that have occurred in the past and repeatedly occur, or due to compression on structures in the shoulder or neck.
There are two common symptoms of TOS: vascular and neuropathic.
Vascular can be characterized by bluish hands which may be due to abnormal blood flow to the hands during overhead activities. There will be coldness and heaviness in the arms when exercising which may be due to impaired blood flow to the extremities. The appearance of pain in the neck, chest, and hands. Or there will be swelling around the hand such as the arm, axilla, or in the collarbone. Of course, you will also feel tired quickly in the upper extremities.
As for Neuropathic symptoms, for example, there is a tingling sensation and even numbness in the medial part, perhaps also shrinkage or muscle atrophy in the hand, so it will be difficult for fine motor activities. Finally, there may be pain in the ulnar nerve distribution pattern.
For TOS, it is divided into 3 types that are all differentiated based on the involvement of structures. The 3 types are: Vascular TOS, Neurogenic TOS and Mixed TOS. Vascular TOS is a type of TOS in which vascular structures will be involved such as the subclavian arteries and veins that provide blood flow to the arms, hands and neck. while for the type of neurogenic TOS, it is a type whose nerves will involve the brachial plexus, for example the ulnar nerve and other nerves that cause numbness in the hands, shoulders and neck and tingling will also occur. As for the Mixed TOS type, it is the only type whose neurovascular structure will utilize nerves and blood vessels.
How would you diagnose a thoracic outlet syndrome? Any clinical investigation or assessment tests? (Note:Don't add treatment to this question)
In this second assignment we revisit the diagnosis of TOS, of which there are several methods to diagnose TOS, but the most commonly used are: By way of history taking which in this method will include checking family history, employment to checking past medical history. Next, there will be a physical examination conducted by a doctor or physical therapist, done by checking the entire body. Further examination with X-rays, ultrasound, and MRI in order to know how far the arthritis is, or the degree of tendon rupture, and damage to the patient's muscles. EMG & NCS will also be performed to determine the extent of nerve damage and muscle strength.
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| Adson Maneuver | Halstead Maneuver | Allen or Weight Test |
It is also necessary to administer some specialized tests in order to confirm the diagnosis. There are several special tests that can be done, namely: Adson Maneuver, Halstead Maneuver and Allen or Weight Test.
The Adson maneuver in this test will be carried out by the patient taking a sitting position, as well as the arms beside him and facing the patient forward, then the therapists will measure blood pressure before carrying out the test, the therapists will also advise the patient to turn his head in an extension position. Not forgetting to tell the patient to also take a deep breath and hold his breath if the symptoms appear again, then the test is classified as positive.
In the Halstead Maneuver test, here will tell the patient to return to a sitting position, then the therapists will measure the radial pulse before the test, then the patient will take the above test position only turning the head to the opposite side, here the therapists will slightly apply downward pulling force and to the location involved. Then feel the radial pulse on the patient, if there is a change in rhythm then the vascular TOS is positive.
In the Allen or Weight Test, will also utilize the patient to take a seated position, the therapist will hyperabduct at the shoulder joint. At that time, the therapists will look for changes in skin color, temperature, and radial pulse in order to see any changes in rhythm.
Physical therapy interventions for Thoracic Outlet Syndrome can take several days to weeks to restore normal range of motion and relieve all the symptoms. There are several exercise videos that we must do in order to normalize these Thoracic Outlet Syndrome patients. So the main role is that we must find out what is the most definite cause of Thoracic Outlet Syndrome and we must also ascertain what type of stage he has experienced because the treatment protocol is certainly different depending on the type.
Try to practice at least 3 exercises that you have learned from the lesson. Share images, gifs or videos while practicing preferably gifs or videos.
I will try to practice 3 therapeutic exercises that have been given in the material by the teacher, among the 3 exercises are: Shoulder Shrugs, Shoulder External Rotation and Straight Arm Shoulder Extension. Here I practice the exercises one by one:
- Shoulder Shrugs
In this exercise, shrugging is done very easily, yes as the name implies, shrugging, but it needs to be done carefully and correctly because we should not bend our heads. The purpose of this exercise is to improve our posture, and will also relieve shoulder tension, as well as strengthen the trapezius muscle, and most importantly increase the mobility of the scapula. We need to do this exercise regularly when we feel weakness or stiffness in the shoulders.
- Shoulder External Rotation
This one exercise is also done in a very easy way, namely by utilizing an elastic cloth or rubber that is pulled sideways using the hand, it needs to be done correctly in order to get the desired results. The purpose of this exercise is that when the shoulder and neck muscles are impaired, the ROM of the shoulder and neck will be limited. The main purpose of this exercise is to complete ADLs and strengthen some muscles in the axilla.
- Straight Arm Shoulder Extension
This one exercise is also done very simply by holding a stick or the like using our two hands while lifting it, but please note that we do it through the back and the stick points to the back, for details can be seen in the video above well.
As for this exercise, it functions if thoracic outlet syndrome, reduced shoulder ROM is most preferred to extension due to muscle weakness or problems with blood vessels. The main function of this exercise is to increase shoulder extension ROM.
Share your review after performing these exercises either on yourself, a healthy individual or a patient.
There are many benefits to Shoulder Raises, Shoulder External Rotations, and Straight Arm Shoulder Extensions, but it all depends on who is doing it. For myself, I feel that this exercise is a good warm-up to reduce tension, improve blood flow, and improve posture, especially since I often sit for long periods of time or lack strenuous activity. As for other healthy individuals, perhaps this exercise can help in maintaining joint stability, possibly to keep injuries away, most importantly for someone who is active in sports. As for TOS patients or those with shoulder problems, they can do exercises like this slowly and under supervision as well. Some movements such as shrugs may promote blood flow, external rotation will stabilize the joint, while arm extension will gradually strengthen the shoulder muscles. Perhaps done with the right routine and intensity, these exercises can go a long way in improving shoulder mobility and overall quality of life.
Thank you for your attention and apologize if there are any mistakes.
@walictd
https://x.com/walictd/status/1881979902632828933
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