^{What's a thoracic outlet syndrome? Write in your own words after getting knowledge from the lesson post.}| ---| Thoracic outlet is the small vennel that is situated in between the shoulder and the neck through which blood vessels and nerves pass. When there is an irritation or a compression of these blood vessels and nerves, it leads to thoracic outlet syndrome. The thoracic outlet way is made up of the first rib, the neck muscles also known as the scalene muscles, the scapula or the shoulder bone and the clavicle or the collar bone. #### Causes of thoracic outlet syndrome * When the structures that are situated around the shoulder and neck region is compressed * If the patient has history of reoccurring injury or an injury from the past * TOS can occur in people who participate in some sports like volleyball, swimming, baseball etc * Injuries like whiplash from trauma such as road accidents as a result of hypertension of hyperflexion of the region of the cervice. * over head Repetitive Carrying of heavy loads. * Poor sleeping posture such as sleeping with the arms extended over the head. ![38C88CB8-2DC4-4806-888C-E484C2915DA4.jpeg](https://cdn.steemitimages.com/DQmUnPWEgLKrqHJkkFPvU3ne5rdQjcNgkxoE6mm2FNLBQAh/38C88CB8-2DC4-4806-888C-E484C2915DA4.jpeg) #### Symptoms of thoracic outlet syndrome The symptoms of thoracic outlet syndrome is classified into neuropathic symptoms and vascular symptoms. **Neuropathic symptoms** * Feeling of numbness or a tingling sensation in the ulnar or the medial region of the nerve pattern * There is presence of pain in the distribution pattern of the ulnar nerve * Musclular atrophy in the hand making it difficult to perform small muscular activities in the hands and wrist regions. **Vascular symptoms** * There is compromise in the blood supply at the extreme’s leading to heaviness or cold feeling in the hands and arms when exercises are performed * The hand turns bluish because of the restriction in blood flow to the hand or arm when overhead activities are carried out. * Swelling of puffy feeling in the hand, arm, Ancilla and clavicle region * Pain in the hand, chest arm or neck * Presence of weakness and fatigue in the upper regions of the body. #### Types of Thoracic outlet syndrome Depending on the structural involvement, thoracic outlet syndrome is divided into three; * **Neurogenic thoracic outlet syndrome:** This type of TOS that involves the nerves of the brachial plexus such as the ulnar nerves amongst others and this lead to numbness and tingling sensation in the hand, arm, axila and the shoulder. * **Vascular thoracic syndrome:** This type involves the vascular structures such as the subclavian artery and the vein that supplies blood to the hand, arm and the neck. * **Mixed thoracic syndrome:** In this type of thoracic syndrome, both the blood vessels and nerves are involved or this can be a combination of both neurogenic and vascular thoracic syndrome. ![5DBD9A32-7F07-4A5F-9CFF-F6058AA274DD.jpeg](https://cdn.steemitimages.com/DQmbjhNwf8fvWe1KmSfFYdHqqHDskx53rPqzSNpC8soU482/5DBD9A32-7F07-4A5F-9CFF-F6058AA274DD.jpeg) ^{How would you diagnose a thoracic outlet syndrome? Any clinical investigation or assessment tests?}| ---| Thoracic outlet syndrome can be diagnosed by the following ways; * Taking into cognizance the patient medical, family, surgical and occupational history of the patient. * Performance of physical examination by a therapist or doctor * Use of ultrasound, X-rays and MRI to check if there are ruptures in the tendons or ascertain damages in the muscles * NSC and EMG will also be performed to access the strength of the muscle or nerve damage. ![4CE5FC76-6BC4-42D8-A5DA-E118CCAA6472.jpeg](https://cdn.steemitimages.com/DQmS6cahkeZzgvNqsPRFhFNH732jXy5W66i7jQSjJGgm4jT/4CE5FC76-6BC4-42D8-A5DA-E118CCAA6472.jpeg) #### Special tests to access thoracic outlet syndrome includes; * Allen or weight test: In this test, the shoulder joint is hyperabducted with the patient sitting down. Changes of the radial pulse is observed to see if there are changes in the rhythm and also changes in the temperature and skin color is looked out for. * Halstead maneuver. This test is carried out with the patient sitting down. The radial pulse of the patient is measured by the therapist before proceeding with the test.The head is rotated to the opposite side while the therapist applies a traction or down award force on the area involved. The vascular thoracic syndrome is positive If there is a change in the radial pulse rhythm. * Adson maneuver: This test is performed with the patient sitting, facing forward with the arm by the side. The blood pressure is measured before the test is performed. The patient is asked to turn the head or neck in an extended position while taking a deep breath or holding the breath. The test is positive of the symptoms are reproduced. ^{Try to practice at least 3 exercises that you have learned from the lesson. Share images, gifs or videos while practicing preferably gifs or videos.}| ---| **The three exercise I practiced are:** * **Shoulder Shrugs** https://youtu.be/kwJcbGwDbB8?si=b8eVUivgf9q4-HX0 This exercise comes in handy when there is the feeling of heaviness or weakness in the shoulder. The shoulder shrug involves raising my shoulder up to my neck while hunching down a little bit as in the video. I relax the shoulder and perform the shrug again for about five times. This helps to alleviate tension from the shoulder, improve posture and the mobility of the scapula and also strengthens the muscles of the trapezoius. * **Scapula Retraction** https://youtu.be/HXSwXL3KQ94?si=D3pq1pp7eZFwCXFx This works on the rhomboids and scalenes which are deep muscle in the neck and it’s helps to stretch and strengthen them. Shoulder retraction is good when there is pain in the upper back region. Simply retract the shoulder inwards as in the video, hold for five to ten seconds and repeat five times. * **Straight Arm Shoulder Extension** https://youtu.be/MzFGUGz-1L4?si=atZnOGTzLcuZKgnK With the hands at the back and a support across the hands like a stick, in this case Inised an umbrella, raise the arms backwards slightly, hold and repeat for about Five times. This helps the muscles of the axillary region and improves shoulder and neck range of motion as the external rotation is needful to complete daily living activities. Note that heat pads should be applied on the exercised parts for 5-10 minutes in order to reduce muscle strain. ^{Share your review after performing these exercises either on yourself, a healthy individual or a patient.}| ---| This exercises are beneficial to improve and strengthen the muscles of the neck and shoulder. The areas exercised felt the impact of the exercises and there was relieve in those regions. Before I leave I want to thank @ashkhan for this therapy intervention and I want to say that the knowledge has been very helpful to me. I used to have plantar fasciitis due to long standing on my legs doing chores and other factors combined until I partook in the class and learnt about one of the therapies which is frozen bottle roll. I started practicing it whenever I feel pains in my plantar fascia. I combined it with standing on my toes and feet massage and It works like magic and now I rarely feel those pains anymore. The knowledge had indeed been very helpful. Thank you. I ask @ugoesther, @gunthertop and @fjjrg to contribute their thoughts on this learning challenge.