Thoracic Outlet Syndrome

Recently at Range of Motion Physical Therapy Lucan, I had a client attend the clinic with what is commonly know as Thoracic Outlet Syndrome (TOS).

The clients symptoms caused them to wake in the middle of the night with numb hands and pins & needles, they described it like sleeping on their arm. The numbness was only present at night and had been ongoing for 2 weeks with no relief.

The client had no history of neck pain or recent injury to neck or shoulders. During history taking the client explained they had recently changed jobs that involved more manual lifting and carrying, with long shifts and long commutes to work by car.

On physical examination there was no pain in neck or shoulder movements, I observed slight restriction in neck movements and very tight neck muscles. Also their posture was not great with rounded shoulders and forward head posture. I was able to recreate the numbness sensation in the arms and hands by compressing down on their collar bone and also having them do a Roos Test.

So what is TOS!

Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the thoracic outlet — the space between your collarbone and your first rib — become compressed. This compression can cause pain in your shoulders and neck and numbness in your fingers/hand.

Common causes of thoracic outlet syndrome include physical trauma, repetitive injuries from work, such as my client – or sports-related activities. There can also be certain anatomical defects, such as having an extra rib, and pregnancy.

Treatment for thoracic outlet syndrome usually firstly involves physical therapy and pain relief measures. With this client I worked on the tight neck muscles and gave home stretches and educated them on their posture. Following the 2nd treatment I reassessed the client and they reported no numbness into their hands.

In addition to the treatment the client also said using a warm hot water bottle around the tight neck muscles helped relief the numbness.

Please contact me should you wish to discuss this issue or any further issues.

 


Shoulder Impingement

Range of Motion Physical Therapy Newsletter Feb 13

Shoulder Impingement

One of the more common injuries I see at Range of Motion Physical Therapy is shoulder pain. Our shoulders are made up of several joints combined with tendons and muscles that allow a great range of motion of the arm. The shoulder is vulnerable to many different problems, I will focus on the more common source of pain and injury, the rotator cuff and impingement.The rotator cuff keeps the head of the humerus in the shoulder socket.

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). This bursa allows the rotator cuff tendons to glide freely when you move your arm. (see image above)

Types of complications:
Tendinitis. The rotator cuff tendons can be irritated or damaged.

Bursitis. The bursa can become inflamed and swell with more fluid causing pain.

Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain.

Rotator cuff injuries are common in both athletes and middle-aged people, athletes who participate in overhead sports such as swimming, baseball, or tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible from over use issues.

Symptoms:

  • Minor pain that is present both with activity and at rest
  • Pain radiating from the front of the shoulder to the side of the arm
  • Sudden pain with lifting and reaching movements

As the problem progresses, the symptoms can worsen:

  • Pain at night lying on shoulder
  • Loss of strength and motion in the shoulder
  • Shoulder pain reaching arm behind the back

I would always advise people seek help for an injury that persists for more than 10 days.

Treatment:

In most cases, initial treatment is conservative involving rest, ice and gradual return to function. A physical therapy treatment will include postural assessment and orthopedic test to identify any postural/muscle imbalances in the shoulder and the cause of the impingement. Treatment will involve hands on soft tissue work, strengthening and stretching targeted muscles, to improve movement patterns and prevent the impingement and pain. As your pain is improving, a shoulder strengthening program for the rotator cuff muscles will be initiated.

If you are suffering from shoulder pain and please contact me for an assessment and treatment. www.romphysicaltherapy.ie

 


Shoulder Impingement

One of the more common injuries I see at Range of Motion Physical Therapy is shoulder impingement pain. Our shoulders are made up of several joints combined with tendons and muscles that allow a great range of motion of the arm. The shoulder is vulnerable to many different problems, I will focus on the more common source of pain and injury, the rotator cuff and resulting in impingement.

The rotator cuff keeps the head of the humerus in the shoulder socket. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). This bursa allows the rotator cuff tendons to glide freely when you move your arm.

Types of complications:

Complications

 

Tendinitis. The rotator cuff tendons can be irritated or damaged.
Bursitis. The bursa can become inflamed and swell with more fluid causing pain.
Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain.
Rotator cuff injuries are common in both athletes and middle-aged people, athletes who participate in overhead sports such as swimming, baseball, or tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible from over use issues.

Symptoms:

Minor pain that is present both with activity and at rest
Pain radiating from the front of the shoulder to the side of the arm
Sudden pain with lifting and reaching movements
As the problem progresses, the symptoms can worsen:

Pain at night lying on shoulder
Loss of strength and motion in the shoulder
Shoulder pain reaching arm behind the back
I would always advise people seek help for an injury that persists for more than 10 days.

Treatment:
In most cases, initial treatment is conservative involving rest, ice and gradual return to function. A physical therapy treatment will include postural assessment and orthopedic test to identify any postural/muscle imbalances in the shoulder and the cause of the impingement. Treatment will involve hands on soft tissue work, strengthening and stretching targeted muscles, to improve movement patterns and prevent the impingement and pain. As your pain is improving, a shoulder strengthening program for the rotator cuff muscles will be initiatated