The Effect of Manual Therapy, Postural Correction and ACUTENS in the Management of Thoracic Outlet Syndrome - A Case Study

Background: Thoracic outlet syndrome (TOS) is a condition that is somewhat controversial and there are no clear-cut clinical guidelines as regards the best way to manage this condition. This case study was designed to evaluate the effect of manual therapy, postural correction and acupuncture like TENS (ACUTENS) in the management of TOS. Methods: The subject was a 33 years old male patient with a four month history of sudden onset of severe pain in the neck with radiation into right upper limb. Patient complained of lower neck pain, muscle weakness in the right upper limb and numbness and tingling sensation in his right hand on his first visit. Following a careful subjective assessment and objective assessment including physical examination, a rehabilitation program comprising of postural correction, manual therapy, pectoralis muscle stretching exercises and ACUTENS were carried out three times weekly for six weeks. Neck pain and disability scale (NPADS) was used to assess pain intensity and the impact of the pain on function, Activity of daily living (ADL) and emotion of the patient. Results: After 6 weeks of treatment, both pain intensity and the impact of pain on emotion was reduced by 80% and 50% respectively. The impact of pain on function and ADL were reduced by 60% and 70% respectively. Patient also reported remarkable improvement with reduction in numbness and tingling sensation. Conclusion: Findings from this case study showed that manual therapy, postural correction, pectoralis muscle stretching exercises and ACUTENS were effective in managing TOS. However, the long term and short term efficacy of using these treatment modalities either singly or in combination and comparison with a non- intervention control group is warranted.