Physiotherapy for THORACIC OUTLET SYNDROME (MANAGEMENT/GUIDELINES)

    

TOS

                   

PHASE-1 (MANAGE ACUTE SYMPTOMS)

1.    TO CONTROL SWELLING

2.    POSITION YOUR ARM IN RESTING POSITION AND MAY USE A SHOULDER IMMOBILISER UNTIL PAIN IS REDUCED

3.    PROM/AAROM/AROM OF SPINE,SHOULDER AND RELATED JOINTS

4.    RHYTHMICAL PASSIVE SIDE FLEXION OF THE NECK AWAY FROM THE SIDE WITH THE SHOULDER GIRDLE ON THE AFFECTED SIDE FIXED TO STRETCH THE SCALENI

5.    HOLD RELAX AND REPEATED CONTRACTION TECHNIQUES TO LEGTHEN THE SCALENI

6.    STRETCH PECTORALIS MINOR, SHOULDER RETRACTORS,SHOULDER LATERAL ROTATORS

7.    IF NERVE PAIN ,THEN USE ICE ,POSITIONING AND DESENSITIZATION TECHNIQUES SUCH AS VIBRATION ,BRUSHING ETC

PHASE-2 (PAIN STABILIZED)

1.    NEURAL MOBILISATIONS FOR SPECIFIC NERVES

2.    INTRODUCE MORE EXERCISES FOR STABILIZATION AND NEUTRAL POSITIONING

3.    MANUAL TECHNIQUES- APPLIED  TO SUPERIOR SURFACE OF THE RIB IN CAUDAL DIRECTION

4.    BY THE END OF THE PHASE THE PATIENT SHOULD BE ABLE TO CONTROL CERVICAL,THORACIC,LUMBAR AND SCAPULAR NEUTRAL POSITIONS IN SITTING,STANDING,SUPINE/PRONE AND SIDE-LYING

PHASE-3 (PROGRESSING TO FUNCTION)

1.    PROGRESS TO FUNCTIONAL MOVEMENT SLOWLY, WITH A FOCUS ON ACTIVELY CONTROLLING NEUTRAL POSITIONS BEFORE ADDING WEIGHT

2.    RECOMMEND ABOUT ERGONOMICS AND WORKING

3.    ADD RESISTANCE TO EXERCISES

·       NO CERVICAL TRACTION

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