• Cohen N

• Thoracic Outlet Syndrome / rehabilitation
• Thoracic Outlet Syndrome / therapy

Clinical Features: A 56-year-old right-handed female employed as a charge nurse who had been involved in 2 motor vehicle accidents (MVAs) reported headaches and neck, bilateral arm and shoulder pain which was much worse on the left than on the right. MRI demonstrated C3-6 degenerative disc disease with C3-4 protrusion and C4-5 and C5-6 bulging. Nerve conduction studies showed slowing bilaterally of the median nerve conductions through the carpal tunnel, and slowing of the ulnar nerve conductions through the elbow. The patient was then referred to a vascular surgeon who performed arterial volume studies. The studies revealed abnormal arterial blood flow through both subclavian arteries with hyperabduction of the arms.

Intervention and Outcome:The patient had initially been treated by the center’s physiatrist who performed cervical epidural injections and facet injections that improved her complaints of neck and arm pain. She was then treated with rehabilitation focusing on muscular imbalances, including tight muscles with trigger points and other muscles with weakness. Postural deficits were identified. The abnormal posture and muscular dysfunctions were addressed with muscle stretching, relaxation and therapeutic exercises. The patient responded well to treatment and was released with good long-term outcome.

Conclusion: Conservative rehabilitation by a doctor of chiropractic, combined with physiatric interventional procedures in a multidisciplinary approach, can provide patients with successful treatment for injuries. Thoracic outlet syndrome, combined with cervical spine joint, disc and nerve root injuries, offer opportunities for this team approach.

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