Abstract

Thoracic Outlet Syndrome (TOS) is a unique and complex pathology that is difficult to diagnose. The participant, in this case study experienced pain and neurological symptoms for two years with no relief. The participant's main concerns are pain management and decreasing the neurological symptoms he is experiencing. Providing relief from these symptoms will allow the participant to return to his activities of daily living.
Significant findings in the initial assessment were: reported pain of 10/10, reduced range of motion (ROM) in the cervical spine and glenohumeral (GH) joint, absent deep tendon reflex (DTR) 7 bilaterally and positive special tests. Posterior-anterior (PA) glides were restricted throughout the cervical spine, and he presented with increased tone in muscles of the cervical spine and bilateral upper limbs. Assessments included ROM exams, peripheral joint scanning exams, and functional exams including functional outcome measures; visual analog scale (VAS) and Neck Disability Index (NDI). Due to neurological involvement, dermatomes, myotomes, DTRs, and special tests for TOS were also completed. Joint play of the cervical spine and palpation occurred prior to each treatment. Only positive special tests were reassessed post-treatment.

Using the Principles of Massage (Rattray & Ludwig, 2000, p.63-65), the participant was treated for ninety minutes each week for seven weeks using neuromuscular techniques, connective tissue techniques, static pressure techniques, proprioceptive neuromuscular facilitation (PNF) and passive stretching. The intent was to increase ROM, decrease pain and neurological symptoms, reduce muscle tone, and superior and inferior joint mobilizations to the clavicle bilaterally. The massage therapy students used assessments and palpation to arrive at a clinical impression that the participant’s TOS was due to a decreased costoclavicular space.

At the end of seven weeks, the participant had increased ROM of the cervical spine, reduced pain, and restored DTRs. The participant reported improved sleep quality with no neurological symptoms when sleeping. At the final reassessment, three of four TOS tests were negative. These findings conclude that massage therapy may effectively treat symptoms of Thoracic Outlet Syndrome.

Objective: To determine if massage therapy is an effective modality to reduce thoracic outlet syndrome symptoms.

Methods: ROM, special tests, and neurological assessment were conducted on the participant. The visual analogue scale (VAS) and Neck Disability Index (NDI) outcome measures were used.

Results: DTR of the triceps (C7-C8) has returned to normal bilaterally (grade 2). Halstead, Modified Wright (Allen), and Adson special orthopedic tests are negative. There was an increase in cervical ROM and reduced neurological symptoms in the arm and hand were noted.

Conclusion: This study indicates that massage therapy may improve symptoms of thoracic outlet syndrome.

Keywords: Thoracic Outlet Syndrome, TOS, Massage Therapy, Scalenes, Costoclavicular.

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