Physical Therapists
Golfer's Elbow
Golfer's Elbow
Physical Therapists
Women's Health Physical Therapy
Women's Health Physical Therapy
Physical Therapists
Intrinsic Foot Strengthening (or The Foot Core)
Intrinsic Foot Strengthening (or The Foot Core)
Physical Therapists
Thoracic Outlet Syndrome
Thoracic Outlet Syndrome
Physical Therapists
Meniscus Injuries

Proper nutrition can help to enhance exercise performance. You are more likely to be tired and perform poorly if you are not getting a balanced diet.

Meniscus Injuries

shoulder pain

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome

The thoracic outlet is formed by the first rib, the clavicle, and the superior border of the scapula. TOS occurs when there is compression of the brachial plexus, subclavian vein or artery. Compression can occur between the anterior and middle scalene, the first rib and the clavicle, or between the pectoralis minor and coracoid process.  It can be due to shortening of the surrounding musculature, hypertrophy of the musculature or trauma to the area.

Common Causes:

  • Poor posture and rounded shoulders 

  • Constant overhead motions 

  • Weightlifting

  • Whiplash

  • Cervical rib (3% of population

Signs and Symptoms:

  • Upper extremity paresthesia/weakness

  • Neck pain

  • Shoulder pain

  • Pain with overhead movements 

  • Atrophy of intrinsic hand muscle (in extreme cases)

Special Tests:

  • Adson’s Test

  • Wright’s test

  • Military test (costoclavicular maneuver)

  • Roo’s test

Goals for Treatment:

  • Mobilization of first rib and shoulder complex

  • Posture correction

  • Stretch muscles that close the thoracic outlet (anterior & middle scalene, pectoralis minor & major, SCM)

  • Strengthen the muscles that open the thoracic outlet (middle & lower trapezius, rhomboids, serratus anterior, latissimus dorsi) 

    • We want high reps & low weight

    • Prone I’s, T’s, Y’s

    • Serratus punches

    • Scapular retractions

    • Scapular retractions arm raises with looped theraband



References:

  1. Borstad, J. D., & Ludewig, P. M. (2006). Comparison of three stretches for the pectoralis minor muscle. Journal of Shoulder and Elbow Surgery, 15, 324-330.

  2. Collins E, Orpin M. Physical therapy management of neurogenic thoracic outlet syndrome. Thoracic surgery clinics. 2021;31(1):61-69. doi: 10.1016/j.thorsurg.2020.09.003.

  3. Hibberd E, Myers JB, Pexa B, Jo Rucinski T, Prentice WE, Schneider R. Rehabilitation of Shoulder Injuries. In: Hoogenboom BJ, Voight ML, Prentice WE. eds. Musculoskeletal Interventions: Techniques for Therapeutic Exercise, 4e. McGraw Hill

  4.  Jones MR, Prabhakar A, Viswanath O, et al. Thoracic outlet syndrome: A comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther. 2019;8(1):5-18. doi: 10.1007/s40122-019-0124-2.

  5. . Levine NA, Rigby BR. Thoracic outlet syndrome: Biomechanical and exercise considerations. Healthcare (Basel). 2018;6(2):68. doi: 10.3390/healthcare6020068.

  6.  The Cervical Spine. In: Dutton M. eds. Dutton's Orthopaedic Examination, Evaluation, and Intervention, 5e. McGraw-Hill; Accessed June 18, 2021. 

The Shoulder Complex. In: Prentice WE. eds. Principles of Athletic Training: A Guide to Evidence-Based Clinical Practice, 16e. McGraw Hill; Accessed June 27, 2021.