Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of Thoracic Outlet Syndrome (TOS), reporting intermittent paresthesia, numbness, and aching pain in the upper extremity, specifically involving the ulnar distribution. Symptoms are exacerbated by overhead activities, prolonged arm elevation, or carrying heavy objects. Patient denies recent trauma, cervical radiculopathy, or systemic inflammatory symptoms.
Clinical Examination Findings
Physical examination reveals positive provocative maneuvers, including the Elevated Arm Stress Test (EAST/Roos test) with reproduction of symptoms within 60 seconds. Adsonβs maneuver demonstrates diminished radial pulse upon neck extension and rotation. Tenderness noted over the supraclavicular fossa and scalene musculature. No evidence of cervical spine instability or focal neurological deficits in the lower extremities.
Treatment Protocol
Initial management focuses on conservative physical therapy emphasizing postural correction, scalene muscle stretching, and scapular stabilization exercises. NSAIDs prescribed for pain management. Referral to occupational therapy for ergonomic assessment. If symptoms persist, consider electrodiagnostic studies (EMG/NCS) or vascular imaging (MRA/Doppler) to rule out neurovascular compromise.