Thoracic Outlet Syndrome

Case Description: Pt. is a 62 y/o female who developed with a 12 year history of RUE lymphedema following a bilateral mastectomy.  In the several months prior to her physical therapy treatment, her RUE paresthesia worsened to the point that is was no longer controlled with her lymphedema arm sleeve and beginning to be painful enough to affect her normal daily tasks.  Her primary care physician suspected the exacerbation may be more complicated than just a flare of lymphedema and proposed musculoskeletal issues were partially at fault.  

Objective Measures: The patient was seen for 12 visits over a 2.5 month period.

Tests and Measures	Initial Evaluation	Day of Discharge from Physical Therapy
VAS for Pain	2-8/10	0-2/10
QuickDASH Scale	54.5 % disability	11.4% disability
R shoulder ROM	Horizontal abduction 20° short of neutral  (with increased paresthesia)	Full horizontal abduction (without increased paresthesia)
Myofascial Tightness	Hypertonic R pectorals, scalenes, upper trapezius	No longer demonstrates significant myofascial restriction in her R upper quarter

Summary: The patient was eventually discharged from physical therapy without report of only mild functional limitation.  The main areas addressed in this complex case were pectoral tightness and scalene tightness, as well as to encourage neuromuscular control to decrease strain on these structures, which commonly play a role in thoracic outlet syndrome.  

Patient Comments at Discharge: “Fewer episodes of severe pain + numbness/tingling.  In last 3 weeks – no episodes (of numbness/tingling)…Sleeping without as many wakeups because of pain.”

Sincerely,

Luke Vander Zouwen, DPT
Full Potential Physical Therapy