1/8. thoracic outlet syndrome in aquatic athletes.thoracic outlet syndrome is a well-recognized group of symptoms resulting from compression of the subclavian artery and vein, as well as the brachial plexus, within the thoracic outlet. Symptoms are related directly to the structure that is compressed. diagnosis is difficult because there is no single objective, reliable test; therefore, diagnoses of thoracic outlet syndrome is based primarily on a set of historical and physical findings, supported and corroborated by a host of standard tests. Because aquatic athletes are primarily "overhead" athletes, one may expect a higher incidence of thoracic outlet syndrome in this population. The differential between TOS and "swimmer's shoulder" (multidirectional instability and subacromial impingement) may be difficult. Nonsurgical treatment methods can be helpful in relieving symptoms; in certain recalcitrant cases, however, surgical intervention can provide lasting relief and a return to aquatic athletics.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. The nocebo effect: do no harm.The nocebo effect creates negative expectations about symptoms and can have devastating influence on patient recovery. Just as the placebo effect works by making patients believe they will get better, the nocebo effect can serve to make patients worse. Two case histories are presented in which patients were assigned diagnoses without objective physical findings. This resulted in poor outcomes. physicians should avoid assigning a diagnosis without objective physical evidence and thus avoid creating the nocebo effect in patients.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
3/8. Thoracic outlet compression syndrome.Forty-nine patients underwent sixty-four procedures for the treatment of the thoracic outlet compression syndrome. Detailed history and careful physical examination are of paramount importance in diagnosing this disease. Our findings strongly suggest that a positive arteriogram is confirmatory evidence of the thoracic outlet compression syndrome. Two problems are identified as the source of unsatisfactory results in this series: poor selection of patients and the regeneration of rib and dense scar tissue with recurrence of compression symptoms. We favor the transaxillary approach to resection of the first rib because it provides satisfactory exposure for removal of the entire rib and utilizes a more cosmetically pleasing incision. Division of muscles, traction on nerves, and entrance into a body cavity are not required, operating time and hospital stay are shortened, and blood loss is minimized. Favorable long-term results were seen in 86 per cent of the patients treated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. Spinal accessory neuropathy, droopy shoulder, and thoracic outlet syndrome.Droopy shoulder has been proposed as a cause of thoracic outlet syndrome. Two patients developed manifestations of neurovascular compression upon arm abduction, associated with unilateral droopy shoulder and trapezius muscle weakness caused by iatrogenic spinal accessory neuropathies following cervical lymph node biopsies. The first patient developed a cold, numb hand with complete axillary artery occlusion when his arm was abducted to 90 degrees. The second patient complained of paresthesias in digits 4 and 5 of the right hand, worsened by elevation of the arm, with nerve conduction findings of right lower trunk plexopathy (low ulnar and medial antebrachial cutaneous sensory nerve action potentials). Spinal accessory nerve grafting (in the first patient) coupled with shoulder strengthening physical exercises in both patients resulted in gradual improvement of symptoms in 2 years. These two cases demonstrate that unilateral droopy shoulder secondary to trapezius muscle weakness may cause compression of the thoracic outlet structures.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. Representation of the thoracic outlet syndrome as a problem in chronic pain and psychiatric management.The diagnosis of thoracic outlet syndrome depends upon subjective complaints and sometimes rather limited physical findings. There is a tendency to favour other non-specific diagnoses, like 'soft tissue damage' or to suspect neurosis, particularly in patients who have had motor vehicle or other injuries for which they claim compensation. We report here 3 patients in whom the diagnosis of thoracic outlet syndrome was overlooked and who responded to surgical treatment with good or excellent results.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. Palpatory diagnosis and manipulative management of carpal tunnel syndrome: Part 2. 'Double crush' and thoracic outlet syndrome.The physician treating carpal tunnel syndrome needs to be aware of the possible concomitant occurrence of thoracic outlet syndrome, the so-called double crush syndrome. palpation is used to differentiate carpal tunnel syndrome from thoracic outlet syndrome. Such palpatory examination assists the physician in planning the initial treatment, including osteopathic manipulation and self-stretching maneuvers, targeted specifically at the most clinically significant pathologic region. Supplemental physical medicine modalities such as ultrasound may enhance the treatment response. Some illustrative cases are reported.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. Therapist management of thoracic outlet syndrome.Treatment of the thoracic outlet patient can be a complex and challenging problem for the occupational or physical therapist. The literature supports conservative care as the preferred approach for these patients; therefore, therapy plays an important role in caring for these patients. I question whether TOS is becoming the RDS of the 1990s. Often these "TOS" patients are suffering from additional secondary system complaints including active myofascial trigger points, primary or secondary glenohumeral joint pathologies, cervical pathology, or more distal peripheral neuropathies. A thorough evaluation by the therapist is extremely important in determining TOS and separating compressive TOS from entrapment TOS. It is only after a thorough assessment that a proper treatment approach can be formulated. Treatment should initially address comfort, control, and relief and then progress to the neurovascular component. Finally, strengthening and conditioning, if tolerated, are implemented. Properly educating the patient to achieve behavior modification, exercise compliance, symptom control, and postural correction is requisite to optimal results.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. shoulder pain in a football player.A 19-yr-old college football player presents with a 1.5-yr history of right shoulder pain and associated easy fatigability of the right arm. The history is significant for an automobile accident 3 yr prior to presentation in which the right shoulder struck the dashboard of the car. An extensive workup proved unremarkable. Treatment included multiple trials of anti-inflammatory medication and extensive physical therapy without benefit. The patient underwent a first rib resection for thoracic outlet syndrome with significant relief of symptoms. thoracic outlet syndrome (TOS) may mimic other more common causes of shoulder and arm symptoms. diagnosis may be difficult as tests are often nonconfirmatory. Conservative treatment usually is adequate. In resistant cases, surgery may be indicated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |