Rehabilitation treatment of the thoracic outlet syndrome (TOS)

Dr Mariem REKIKa, Dr Aymen HAJ SALAHa, Dr Mouna SGHIRa, Dr Imene KSIBIb, Dr Wafa SAIDa, Prof Wassiaa KESSOMTINIa

a CHU Taher Sfar Mahdia, b Hôpital Militaire Principal d'Instruction de Tunis

Objective. Identify the different modalities of rehabilitative care of TOS through a review of the literature and our experience in the unity of physical medicine and rehabilitation (PMR) in Mahdia.

Material and methods. A retrospective study during the last three years including patients with TOS addressed to the unity of PMR of Mahdia. The evaluation was clinical (visual analogue scale pain VAS, examination of the cervical spine and dynamic tensioning test of the brachial plexus), functional (Orset stage) and radiological. A program of 15 rehabilitation sessions has been achieved.

Results. 14 patients (13 women and one man) with a mean age 39.92 years were collected. Symptoms were primarily neurological with paresthesia in 71.42%, a C8-D1 cervical radiculopathy in 21.42% of cases, heaviness in the upper limbs in 14.28% of cases. Venous symptoms and hand edema were found in 28.57% of cases. Raynaud's syndrome was found in only one case (7.14%). The Wright manoeuver was positive in 35.71% of cases and Roos test was positive in 78.57% of cases. The dynamic test revealed a tensioning of the brachial plexus by the median nerve in 57.14% of cases and by the ulnar nerve in 42.85% of cases. A double crush syndrome was found in 21.42% of cases. Initial average pain VAS was 73 mm. Radiological assessment revealed a cervical rib in 14.28% of cases and mega-apophysis C7 in 21.42% of cases. After rehabilitation, there was an improvement in pain (mean VAS 21 mm) and short-term results were good in 78.57% of cases.

Discussion and Conclusion TOS rehabilitation is often efficient; it corrects the muscle imbalance reducing the diameter of the thoracic outlet and decompensating his asymptomatic constitutional smallness. If there are no serious vascular or neurological complications, it remains the first-line treatment.

Keywords : thoracic outlet syndrome,rehabilitation