PREFERRED PRACTICE PATTERN
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Rang of Motion Associated with Localized Inflammation
Patient is a 23-year-old male who is in the army. Patient complains that both of his arms feel heavy. He has a cold sensation in his hands. Patient spent the last 2 weeks in boot camp. He had to hike 5 miles a day while wearing a fully loaded back pack. The heaviness has begun since he started with the hiking. The patient has a positive costoclavicular thoracic outlet test.
Entrapment of the neurovascular bundle comprising the brachial plexus, subclavian artery and/or subclavian vein, neurogenic or vascular types (venous and arterial)
Symptomatology and management is different depending on the primary structure compressed
Diagnosis is made by clinical examination and thorough diagnosis of exclusion
Most common to least common incidence is brachial plexus, subclavian artery, and subclavian vein compression, respectively2
Thoracic outlet syndrome involving the subclavian vein and artery requires immediate medical attention and is often the result of trauma or clot3
Worse with repetitive postural habits, pain at rest, night pain4
Young and middle-aged adults most commonly affected6
Females to males 3:16
Can develop spontaneously, gradual onset due to poor posture or post-trauma
Teenagers with a cervical rib
There is increased incidence with participation in sports
Correlated with a high incidence of forward head carriage and rounded shoulders7
SIGNS AND SYMPTOMS
Intermittent numbness and tingling in the forearm, wrist and hand
Feeling of weakness and fatigue in the upper extremity (UE) especially with arm overhead
Pain in the arm, neck, shoulders, and upper back
Aggravated by overhead activities, repetitive activities, and activities that depress the shoulder girdle4
Pain is worse at night.4,8
Pain can be better with rest
Postural examination may reveal low lying shoulder girdle on affected side, forward head carriage, and anteriorly rounded shoulders6
Isolated venous type of thoracic outlet syndrome presents with unilateral UP edema, pain, ...
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