Considerations on rehabilitation of cervicothoracobrachial outlet syndrome

Abstract

The conservative treatment of the thoracic outlet syndrome (TOS) as proposed by Peet in 1956 prevailed a long time and still remains, for many physiotherapists, the technique of reference. However, during these last 20 years, many authors have published improvements to this technique. The Walsh program, published in 1996, is advantageous on the one hand because it utilizes all the evaluation data, and on the other hand, it separates compressive TOS from entrapment TOS, with the latter limiting plexus mobility in proportion to extraneural and/or intraneural fibrosis. The treatment program includes three stages. The goal of the first stage is to control the symptomatology and to obtain comfort. The second stage concerns more directly the pathological tissues: musculoskeletal surroundings for compressive components and mobilization of the nervous system according to Butler, Totten and Hunter protocols for entrapment components. The third stage aims to condition and strengthen the postural muscles. A home rehabilitation program is also addressed. The patient's ability to tolerate daily living and professional activities depends on the pursuit of the home program in accordance with evolution.