Passive and active rehabilitation after first rib resection

Abstract

It is clear to all that patients with neurogenic thoracic outlet syndrome (NTOS) require rehabilitation following first rib resection. The post-surgical treatment protocol described below has been designed using published research evidence together with 22 years of clinical experience treating pre- and post-surgical patients with (NTOS). Breathing training is performed before and after surgery. Pre-surgical breathing training is focused on relaxing the accessory breathing muscles by emphasizing the diaphragm. This helps to unload the hyperactive accessory breathing muscles. Post-operative training emphasizes diaphragmatic breathing to reduce the mechanical load on the surgical site but also emphasizes periodic full inhalation to maximize lymphatic flow and mobilize the brachial plexus in an attempt to reduce excessive scar formation around the surgical site. Manual cutaneous and subcutaneous mobilization of the scar, once it is healed enough to tolerate gentle stretching, is addressed, as are range of motion exercises to emphasize restoration of both neural and musculoskeletal movements. Retraining of the core stabilizers is helpful, as is cardiac re-conditioning with walking training. Finally, periods of rest are encouraged to minimize the opportunity of over-exercise and the symptom flares that this can cause.