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Management of Thoracic Outlet Syndrome with a Sympathetic Presentation.

Background and Purpose: Thoracic outlet syndrome (TOS) and T4 syndrome can present with similar clinical findings through different pathoanatomical and pathophysiological means. This case report describes the management of a patient diagnosed with TOS with a sympathetic presentation. Methods: A 31-y...

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Published in:Orthopedic Physical Therapy Practice Vol. 36; no. 4; pp. 18 - 23
Main Authors: Rivera, Oliver, Griffin, Kristina
Format: pictorial research Journal Article
Published: Orthopaedic Section, APTA, Inc. 2024
Online Access:View this record in EBSCOhost
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      dt: 2024
      vid: 36
      iid: 4
      pid: 38232
      pub: Orthopaedic Section, APTA, Inc.
      place: La Crosse, Wisconsin
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        atl: Management of Thoracic Outlet Syndrome with a Sympathetic Presentation.
      aug:
        au:
          Rivera, Oliver
          Griffin, Kristina
        affil: University of Illinois at Chicago, Faculty Practice, Chicago, IL
      sug:
        subj:
          Thoracic Outlet Syndrome Therapy
          Autonomic Nervous System Diseases Diagnosis
          Thoracic Outlet Syndrome Diagnosis
          Skin Manifestations Etiology
          Sympathetic Nervous System
          Male
          Adult
          Paresthesia Etiology
          Body Temperature Changes Etiology
          Skin Diseases Etiology
          Neck Pain Etiology
          Shoulder Pain Etiology
          Adult: 19-44 years
          Male
      ab: Background and Purpose: Thoracic outlet syndrome (TOS) and T4 syndrome can present with similar clinical findings through different pathoanatomical and pathophysiological means. This case report describes the management of a patient diagnosed with TOS with a sympathetic presentation. Methods: A 31-year-old male presented with a 2-year history of upper extremity pain and paresthesias, temperature changes, discoloration, and neck pain after increasing exercise frequency. Two episodes of discoloration in all extremities with subjective "heart racing" sensation lasting less than 5 minutes were also reported. Clinical Findings: A positive venogram for venous TOS was reported. Objective examination demonstrated positive TOS testing, limited thoracic and first rib mobility, and skin temperature fluctuation and discoloration after a push-up task. A thoracic manipulation to T4 resulted in resolve of skin temperature fluctuation. Clinical Relevance: A thorough subjective and objective examination was necessary to navigate this patient's presentation, evaluate the findings, and consider interventions. Sympathetic symptoms are often due to a thoracic dysfunction and management with thoracic manipulation should be considered. Conclusion: A patient presenting with skin temperature fluctuation after a push-up task resolved symptoms after thoracic manipulation.
      pubtype: Periodical
      doctype:
        pictorial
        research
        Journal Article
      ougenre: Article
    language: English
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