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Diagnosis and treatment of a patient with bilateral thoracic outlet syndrome secondary to anterior subluxation of bilateral sternoclavicular joints: a case report.
[thoracic outlet syndrome]
Thoracic
outlet
syndrome
may
result
from
a
posterior
sternoclavicular
(
SC
)
joint
subluxation
,
or
an
anterior
SC
joint
subluxation
after
surgical
fixation
.
This
case
report
presents
the
physical
therapy
management
of
a
patient
with
bilateral
thoracic
outlet
syndrome
(
TOS
)
secondary
to
bilateral
idiopathic
anterior
SC
joint
subluxation
.
A
16
-
year
-old
female
presented
with
a
2
-
year
history
of
numbness
,
tingling
,
and
coldness
in
bilateral
upper
extremities
,
and
intermittent
headaches
with
occasional
vision
loss
.
Ipsilateral
upper
extremity
symptoms
were
reproduced
with
cervical
rotation
and
shoulder
flexion
and
abduction
from
90
°
to
end
of
the
range
.
All
TOS
tests
were
positive
.
Passive
horizontal
abduction
,
through
the
plane
of
scaption
,
produced
anterior
subluxation
of
the
ipsilateral
SC
joint
.
Sustained
posterior
glides
to
the
medial
clavicle
relieved
all
symptoms
during
shoulder
flexion
and
the
Adson
's
test
.
Interventions
consisted
of
manual
therapy
,
therapeutic
exercise
,
and
the
trial
of
two
orthoses
.
After
12
treatment
sessions
,
the
patient
's
symptoms
resolved
and
she
improved
by
10
points
on
the
Upper
Extremity
Functional
Index
.
She
had
no
reproduction
of
symptoms
with
the
thoracic
outlet
special
tests
.
She
maintained
a
static
hold
for
90
sec
at
90
°
shoulder
flexion
,
90
°
shoulder
abduction
,
and
full
shoulder
flexion
without
symptoms
.
The
outcomes
describe
a
successful
intervention
for
a
patient
with
bilateral
TOS
secondary
to
idiopathic
bilateral
anterior
SC
joint
subluxation
.
This
case
suggests
that
SC
joint
dysfunction
should
be
considered
as
a
cause
of
TOS
and
should
be
screened
during
the
initial
examination
.
Diseases
Validation
Diseases presenting
"posterior sternoclavicular"
symptom
thoracic outlet syndrome
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