NTOS from the physical therapists' point of view

Abstract

The purpose of this chapter is to discuss the evaluation by a physical therapist of a patient who has been diagnosed as having neurogenic thoracic outlet syndrome (NTOS). Such an evaluation is designed to obtain the facts that will guide both the technique and vigor of treatment. The initial evaluation can be separated into three sections: First, subjective evaluation of the history of symptoms (with emphasis paid to characteristic pain patterns and their persistence), numeric assessment of current symptoms, and functional assessment (ideally using a standardized functional questionnaire). Second, an objective evaluation, including assessment of active movements and palpation, to determine both the sensitivity of the nervous system and to help differentiate various other problems from NTOS. Emphasis is placed on tests that are performed at every treatment session to assess the effect of the treatment. Finally, emphasis on evaluation of motor dysfunction (Kabat test), breathing, and neurodynamics of the brachial plexus are performed.