Treatment of Thoracic Outlet Syndrome & Carpal Tunnel Syndrome ????

Hey physios,

I would appreciate if anyone could help me out with a treatment for thoracic outlet syndrome and carpal tunnel syndrome... Please include those for all the stages,,,

Cheers

Sorry guys for the double reply..

Hi,
:)
For cervical ribs and scaleneus syndrome, as much as possible, conservative measures should be tried esp. for those cases which seem to improve with rest. To relieve the strain on the lower brachial plexus and roots the shoulder should be brought upward and backward with a sling or brace.Emphasis should be given on strengthening the trapezius muscles & levator scapulae muscles. Aggravating factors should be avoided and a change of occupation that does not strain the shoulder or arm will result in complete relief of symptoms. Postural exercises is a must. If it doesnt relieve and has no resposne to conservative measures then surgery is the only option for that.
:D
Regards,
charlize29

For thoracic Outlet Syndrome :

Use modalities to treat pain. You may use any one of them. These are superficial heating methods like Infrared, electrical heating pads, moist heat packs, etc & deep heating methods which are SWD, Micro wave diathermy, ultrasound. TENS and Interferential are also helpful.

Strength and endurance training exercises for the shoulder elevators.

Stretching exercises especially for the scalene muscles and pectoralis minor.

Posture correction exercises

Moblization and manipulation procedures to address the joint stiffness in the spine. (Moblization of the first rib)

Stretch and spray therapy as described by Jenet Travell and D.G. Simon ( Myofascial pain and Dysfunction)

Mobilize the restricted nerve tissue by using the nerve mobilization maneuvers if nerve tension tests are positive.

For Carpal Tunnel Syndrome:

Modalities:

The use of modalities can be given to reduce swelling and pressure within the carpal tunnel. They of great benefit in improving the condition. Ice, ultrasound, iontophoresis, phonophoresis, LASER can be used with great success.

Stretching and Strengthening:

A specific strengthening and stretching exercise programme can improve the strenght and dexterity of hand.

Massage, Nerve gliding and Neural Tension:

Massage, nerve gliding and neural tension techniques can be give but their results are unproven and give no real benefit.

Mobilization of Median Nerve. Mobilize the median nerve if neural tension tests are positive. The procedure for that is as follows. Begin with the pateint supine; sequentially apply the shoulder girdle depression, then slightly abduct the shoulder, extend the elbow, laterally rotate the arm and supinate the forearm. Wrist, fingers and thumb extensions are then added; finally the shoulder is taken in to greater abduction. The full stretch position include contralateral cervical side flexion. Whiile maintaining the stretch position, move one joint at a few degrees in and out of stretch position, such as wrist flexion and extension, or elbow flexion and extension. This maneuver is beneficial when examining and treating the symptoms related to median nerve distribution, problems with shoulder girdle depression ( such as thoracic outlet syndrome, carpal tunnel syndrome.


Manipulation:

Manipulative techniques used to stretch & manipulate the carpal tunnel give benefit and improve the condition, although they are not widely accepted.

Ergonomic Advice:

Work sit eassessment help to reduce potential excerbating factors (such as poor posture, excessive force).

Wrist Splints:

Patients with mild to moderate CTS respond well to the conservative programme of night time splintting in neutral position for a minimum of 3-4 weeks and is the best evidence based practice in use.

I think that this will be of help to you.

hi
can u please tell about,tendon gliding & median nerve gliding in carpel tunnel syndrome

Stretch and spray therapy is one of the popular and effective treatment methods used in the management of myofascial pain syndromes and myofascial trigger points in muscles; hence so will be effective the myofascial component of the thoracic outlet syndrome. Vapocoolants are used in the spray, the two most commonly used are ethyl chloride and Fluori Methane sprays. The sequence of steps used in the stretch and spray of any muscle for myofascial trigger point is as follows.

Patient is supported in a comfortable relaxed position. One end of muscle is anchored. Skin is sprayed with rapid parallel sweeps of vapocoolant over the length of muscle in the direction of pain pattern. All of the muscle is covered. Immediately after the first sweep of spray, pressure is applied to stretch the muscle and is continued as spray is applied. Sweeps of spray are continued to cover the referred pain pattern of that muscle. All this is repeated two to three times or less if the passive range of motion becomes maximum. Hot pack and several cycles of active full range of motion follows.

hi

instead of spray and stretch very good results acheive(after Chaitow) using
ischemic pressure followed by positional release and postisometric relaxation.:)

thanks
Yaro

just wanna share this..


Millions of Americans have been diagnosed with carpal tunnel syndrome. If you're one of them, you have pain, numbness and strange sensations in your fingers, hand, wrist and arm. These symptoms are caused by nerve entrapment, in which a nerve in your wrist that conducts sensations and pain has been pinched or crushed.
Additional Comment I forgot:
Carpal tunnel syndrome is a difficult problem to solve, due to the lack of any "quick fix", there is no pill or method that can eliminate it quickly. However, some anti-inflammatory drugs and pain medications have demonstrated the ability reduce the symptoms and intensity of the condition, while still not providing a permanent solution. Surgical treatments exist, but as is usual for procedures of this type, there is no guarantee of its effectiveness and there is potential for exacerbating the condition.

Try this easy exercise to stretch the tendons and ease the symptoms of carpal tunnel syndrome.

1. Extend your wrists and fingers outward, ahead of your body, positioning your hands and fingers toward the ceiling, like you are signaling someone to "stop".

2. Wait five seconds in this position, then relax and straighten both wrists in front of the torso.

3. Keeping the arms straight out front, clench both hands in a fist.

4. Rotate the wrists down to the floor while maintaining a fist and then hold for five seconds.

5. Relax and straighten both wrists and hands into their normal position and repeat the above steps for as many as five to seven more times.

For TOS Chiropractors can adjust ribs whether it be the first rib or a cervical rib. It's one more option prior to surgery and as far as carpal tunnel goes usually its a tight pronator teres which usually isn't addressed until after unsuccessful surgery. Worth a try.:)

Often one must make sure if it is truly TOCS or TOS or if indeed it is carpel tunnel syndrome.

The TOCS or TOS can be treated by doing release therapy to the scalenus anticus and medius. Try this first after your assessment. This is often the problem.

Carpel tunnel syndrome is the popular find of surgens and physicians, but it can be a supinator and pronator imbalnace.

Make sure that the diagnosis is correct by good assessment.

Best regards,

Neuromuscular.

I was searching for this one found here thanks a lot.

1) Rx Carpal tunnel

You have to first check whether it is Carpal tunnel Syndrome or not-

I have worked in NIMHANS and many times we had patients mis-diagnosed carpal tunnel when it was either cervical spondylosis or tennis elbow with the tingling sensation down the fingers, in case you plan to do a NCV it might be useful instead get a xray done of yr neck or get a physio to examine your wrist and do a tinel's sign- test
Are you a diabetic ? it could be diabetic neuropathy also
it can also be a pressure on nerve similar to TOCS

take ultrasound pulsed mode over your carpal bones you ll feel much better

2) Rx TOCS

it is an RSI or seen by birth, have you confirmed the diagnosis ?
an MRI should help you out to confirm, usually a Clinical test Roos is effective in diagnosing the condition.
did you get an Xray done ? Any cervical ribs present ?

Queries reply [email protected] ;)
Additional Comment I forgot:
surgery has its own advantages and disadvantages, just confirm the diagnosis before surgery,think and get yourself examined before the surgery..

use a cold pack, and give lateral glides along and then Pa glides to reduce pressure off the nerve for carpal tunnel .

Use a hot pack place it on the upper chest on the side of the pain,and ULTT will give u relief,
Non medical terms Start with bending head towards the side of the pain and touching your ear with the arm on that side, then hold 5 secs,
Bend your head on the other side and Stretch your hand straight on the side at app 90 degrees hold 5 secs

Hope it helps