Thoracic Outlet Syndrome
1. She began rehab with her certified athletic trainer until the end of the season. SHe then continued with physical therapy, including stretching and augmented soft tissue mobilization (ASTYM) of the anterior and middle scalene, pectoralis major and pectoralis minor. In addition, strengthening of the rotator cuff and scapulothoracic muscles and postural training were performed.
2. She avoided hyperabduction and carrying heavy objects with the right arm.
3. The patient failed to improve with the above regimen and was still symptomatic after 16 weeks. She was referred to vascular surgery for evaluation.
4. The patient underwent a decompression of her right thoracic outlet including a partial first rib resection, brachial plexus neurolysis, as well as an anterior and middle scalenectomy.
1. Testing four weeks post-operatively demonstrated a strong right radial pulse at rest and with hyper-abduction and the absence of any symptoms of pain, numbness, or swelling.
2. She continued to improve and demonstrated complete resolution of her symptoms by eight weeks after surgery and began a functional return to pitching progression. She returned to full competition and remains completely asymptomatic.
-Thoracic outlet syndrome may present without shoulder or upper arm pain.
-Thoracic outlet syndrome should be considered in the differential diagnosis of all overhead athletes with upper extremity pain.
-Provocative maneuvers including Roos, Wright's and Adson's testing should be performed if thoracic outlet syndrome is suspected.
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