INTRODUCTION:- Thoracic outlet is the opening through which the thorax communicates with the root of neck. It is a group of disorder that occur when blood vessels or nerves in the space between clavicle and the first rib. It is the presence of neurological symptoms due to compression of :-
i) brachial plexus
ii) subclavian artery at the outlet of thoracic cage.
CAUSES:- 💧 Tight Scalene muscle
💧 can be associated with dislocation of clavicle.
💧 tight pectoralis minor muscle
💧 presence of cervical rib (extra rib)
💧 adaptive shortening of fascia.
💧 faulty posture
DIAGNOSIS:- ADSON'S TEST- In this test, the radial pulse is 1st palpated, then the shoulder of affected side is extended, abducted and externally rotated, if the radial pulse is vanish then the test is POSITIVE.
WRIGHT'S MANEUVRE- The patient after palpating his pulse is asked to abduct the shoulder to 90 degree, then externally rotated and go into 5-10 degrees hyperextension. If pulse is vanished, the test is POSITIVE.
ROOS TEST:- Also known as Elevated Arm Stress Test (EAST). The patient's shoulder should be abducted to 90 degrees, externally rotated with elbow flexed to 90 degrees. Ask the patient to open and close the hands for 3 minutes. The patient will not be able to do that., then the test is POSITIVE.
CLINICAL FEATURES:- The patient will feel pain, tingling, numbness in hand along the ulner nerve distribution. There will be difficulty in performing overhead activities repeatedly especially involving external rotation. There will be weakness in the grip of the hand in advance cases especially the precision part.
MANAGEMENT:- Inter-cervical traction for 10 minutes. U.S. is applied in between the clavicle and scapula. To reduce pain IFT or TENS is given along the course of nerve. ULTT3 is also tried alongwith stretching of scalene, pectoralis minor. Exercise of hands to improve hand function
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