The Multidisciplinary Conservative Approach in Treatment of TOS

Objectives: The aims of this study were to evaluate the efficacy of conservative treatment in patients with and without cervical ribs and Thoracic Outlet Syndrome (TOS). From so many kinds of conservative treatment in literature, we used a multidisciplinary approach (correction of posture, maximizing muscle endurance and power, stretch shorten muscles, massage for trigger points and maximize thoracic span with stomach breathing) to get more effective treatment and a longer time of relief with less duration and more long-term relief. Methods: Twenty six female patients with or without cervical ribs, pain and numbness were included in this study. They were assessed in terms of posture, muscle testing and shortness in muscles in all part of the body. Initial pain status were recorded and after eight weeks treatment including posture correction, their pain were assessed again with visual analogue scale that ۰ was no pain and ۱۰ was intolerable pain. Results: In ۱۰۰ % of patients initial pain score were more than ۵ in visual analogue scale. ۲۳.۱% of cases showed reduced pain scores to lower than ۵ scales. Age was not a significant factor (P=۰.۹۳) on pain reducing. Type of posture was independent from pain and pain diminishing (۰.۰۰۴). Cervical rib was effective in initial pain (P=۰.۰۸) and degree of diminishing pain (P=۰.۲۳۶). Initial pain of ۵۷.۱% of patients with cervical rib was ۱۰ due to visual analogue scale (VAS). In ۳۳.۳% of the persons with bilateral cervical rib we saw more than ۵ degree in diminishing pain. In the ۸۵.۷% patients with unilateral cervical rib, we had more than ۵ degree diminishing pain and we saw this in all of the non cervical rib TOS. Dicussion: Faulty posture can cause narrowing of the thoracic outlet space and may lead to pain and numbness, and some other symptoms. Correction of posture despite of cervical rib can widen the space and reduces pressure on vessels and nerves. Postural correction and long time follow up must be considered in order to get longtime relief.

کلیدواژه ها:

Thoracic outlet syndrome ، Pain ، Conservative treatment ، Posture