nerve gliding exercises for thoracic outlet syndrome pdf
Nerve Gliding Exercises for Thoracic Outlet Syndrome
Nerve gliding exercises (NGE) are an important part of the treatment of thoracic outlet syndrome (TOS), whether conservative or surgical․ They also can be useful for other peripheral nerve problems․ Nerve gliding exercises for thoracic outlet syndrome Hand Clin․ 2004 Feb;20 ․․․
What is Thoracic Outlet Syndrome?
Thoracic outlet syndrome (TOS) is a condition that occurs when the nerves and blood vessels that run from your chest to your arm are compressed․ This compression can happen in a few different places, including⁚
- Between your collarbone and your first rib⁚ This is known as the costoclavicular space․
- Between your shoulder blade and your first rib⁚ This is known as the subcoracoid space․
- In the space between your neck muscles and your collarbone⁚ This is known as the scalene triangle․
TOS can affect both the nerves and the blood vessels in your arm․ When the nerves are compressed, you may experience symptoms like numbness, tingling, pain, or weakness in your arm, hand, and fingers․ When the blood vessels are compressed, you may experience symptoms like swelling, discoloration, or coldness in your arm․
TOS is a relatively common condition, affecting approximately 8% of the population․ It can be caused by a variety of factors, including⁚
- Congenital abnormalities⁚ These are birth defects that can cause compression of the nerves and blood vessels in the thoracic outlet․
- Trauma⁚ An injury to your neck, shoulder, or chest can cause compression of the nerves and blood vessels in the thoracic outlet․
- Repetitive motions⁚ Certain jobs or activities that involve repetitive motions of the arms and shoulders can contribute to TOS․
- Poor posture⁚ Slouching or hunching over can put pressure on the nerves and blood vessels in the thoracic outlet;
Causes of Thoracic Outlet Syndrome
Thoracic outlet syndrome (TOS) can arise from a variety of factors, making it a complex condition to pinpoint․ The root cause often lies in a combination of anatomical variations, external pressures, and repetitive movements․ Understanding these contributing factors is crucial for effective treatment and management․
- Anatomical Variations⁚ Some individuals are born with anatomical variations that can predispose them to TOS․ These include⁚
- Cervical Rib⁚ An extra rib extending from the cervical vertebrae, causing pressure on the brachial plexus and subclavian artery․
- Abnormal Muscle Attachments⁚ Variations in muscle attachments, such as a high insertion of the scalene muscle, can compress the neurovascular structures․
- Trauma⁚ Injuries to the neck, shoulder, or chest can lead to TOS․ This can include⁚
- Whiplash⁚ Sudden neck movements can strain the muscles and ligaments, potentially compressing the nerves and vessels․
- Fractures⁚ Fractures of the clavicle, ribs, or scapula can create space restrictions in the thoracic outlet․
- Repetitive Movements⁚ Certain occupations or activities that involve repetitive movements of the arms and shoulders can contribute to TOS․ These include⁚
- Construction Work⁚ Holding heavy tools or performing overhead work for prolonged periods․
- Computer Use⁚ Maintaining poor posture while typing or using a mouse can strain the neck and shoulder muscles․
It’s important to note that in some cases, the specific cause of TOS may remain unclear․ However, recognizing the contributing factors can help guide treatment and prevent future episodes․
Types of Thoracic Outlet Syndrome
Thoracic outlet syndrome (TOS) is categorized into three primary types, each affecting different structures within the thoracic outlet and presenting with distinct symptoms⁚
- Neurogenic Thoracic Outlet Syndrome (NTOS)⁚ This is the most common type, accounting for approximately 95-98% of cases․ NTOS occurs when the brachial plexus, a network of nerves that control movement and sensation in the arm and hand, is compressed․ This compression can result in pain, numbness, tingling, weakness, and impaired dexterity in the affected arm․
- Arterial Thoracic Outlet Syndrome (ATOS)⁚ ATOS involves compression of the subclavian artery, the main artery that supplies blood to the arm․ This compression can lead to a decrease in blood flow, causing symptoms like pain, numbness, coldness, and pallor in the affected arm․ In severe cases, ATOS can even cause a blood clot to form in the artery, leading to a serious condition called arterial thrombosis․
- Venous Thoracic Outlet Syndrome (VTOS)⁚ VTOS occurs when the subclavian vein, which carries blood from the arm back to the heart, is compressed․ This compression can impede blood flow, resulting in swelling, pain, and discoloration in the arm․ VTOS can also cause a blood clot to form in the vein, leading to a condition called venous thrombosis․
While each type of TOS affects a specific structure, it’s important to note that these conditions can sometimes overlap, making diagnosis more complex․ A thorough medical evaluation, including history taking, physical examination, and imaging studies, is necessary to determine the precise type of TOS and guide appropriate treatment․
Symptoms of Thoracic Outlet Syndrome
The symptoms of thoracic outlet syndrome (TOS) can vary widely depending on the type of TOS and the specific nerves or blood vessels affected․ However, some common symptoms include⁚
- Pain⁚ This is often the most prominent symptom and can range from mild to severe․ It can be localized to the neck, shoulder, or arm, or it can radiate down into the fingers․ The pain may be worse with certain movements, such as lifting the arm overhead or turning the head․
- Numbness and Tingling⁚ These sensations can occur in the fingers, hand, or forearm, and they may be intermittent or constant․ The numbness and tingling are often worse at night or when the arm is held in a particular position․
- Weakness⁚ This symptom can affect the muscles of the hand, forearm, or shoulder․ It may make it difficult to perform tasks that require fine motor skills, such as writing or buttoning clothes․
- Swelling⁚ This symptom is more common in venous TOS and is often localized to the arm or hand․ It may be worse in the evening or after prolonged periods of activity․
- Coldness or Discoloration⁚ These symptoms are more common in arterial TOS and are often localized to the fingers or hand․ The fingers may feel cold, numb, or pale, especially in cold weather․
It’s important to note that these symptoms can also be caused by other conditions, so it’s essential to see a doctor for a proper diagnosis․ If you experience any of these symptoms, especially if they are persistent or worsening, it’s important to seek medical attention․
Conservative Treatment for Thoracic Outlet Syndrome
Conservative treatment for thoracic outlet syndrome (TOS) aims to relieve symptoms and improve nerve and blood vessel function without surgery․ It often involves a combination of approaches, including⁚
- Physical Therapy⁚ This can include exercises to improve posture, strengthen muscles, and increase range of motion in the neck, shoulder, and arm․ Physical therapists can also teach you how to perform nerve gliding exercises, which can help to reduce pressure on the nerves․
- Medications⁚ Nonsteroidal anti-inflammatory drugs (NSAIDs) can help to reduce pain and inflammation․ In some cases, your doctor may prescribe corticosteroids to reduce inflammation or nerve pain․
- Lifestyle Modifications⁚ This may involve avoiding activities that trigger your symptoms, such as prolonged computer use, heavy lifting, or sleeping with your arm over your head․ You may also be advised to wear a sling or brace to support your arm and reduce pressure on the nerves․
- Injections⁚ In some cases, your doctor may inject corticosteroids into the space around the brachial plexus to reduce inflammation and pain․
Conservative treatment is often successful in relieving symptoms of TOS․ However, if your symptoms are severe or don’t improve with conservative treatment, surgery may be an option․ It’s important to talk to your doctor about the best treatment options for you․
Chin Tuck
The chin tuck exercise is a simple yet effective way to improve posture and reduce pressure on the nerves in the neck and shoulder․ It helps to lengthen the muscles at the back of the neck and strengthen the deep neck flexors, which can contribute to better nerve gliding․
- Starting Position⁚ Sit or stand with your back straight and shoulders relaxed․ Look straight ahead․
- Action⁚ Gently tuck your chin towards your chest, as if you were trying to create a double chin․ You should feel a slight stretch in the back of your neck․
- Hold⁚ Hold this position for 5-10 seconds, then relax․
- Repetitions⁚ Repeat this exercise 10-15 times, 2-3 times a day․
It’s important to avoid excessive neck movement and focus on a subtle tuck of the chin․ If you experience any pain, stop the exercise and consult with your doctor or physical therapist․
Chest Stretch
A tight chest can contribute to poor posture and increase pressure on the nerves in the thoracic outlet․ This stretch helps to lengthen the pectoral muscles, improving flexibility and allowing for better nerve gliding․
- Starting Position⁚ Lie on your back with your knees bent and feet flat on the floor․ Place a foam roller underneath your upper back, ensuring your neck is supported․ Extend your arms out to your sides, palms facing upwards․
- Action⁚ Allow gravity to gently pull your arms down, creating a stretch across your chest and shoulders․ You should feel a deep stretch in your pectoral muscles․
- Hold⁚ Hold this position for 30-60 seconds, breathing deeply and relaxing into the stretch․
- Repetitions⁚ Repeat this stretch 2-3 times a day․
Ensure your neck remains comfortable throughout the exercise․ If you feel any pain, stop immediately and consult with your doctor or physical therapist․
Scapular Push-Up Plus
This exercise strengthens the muscles that support the shoulder blades, promoting proper scapular movement and reducing compression in the thoracic outlet․ It also helps improve posture and reduce muscle tension in the neck and shoulders․
- Starting Position⁚ Start on your hands and knees, with your shoulders stacked over your wrists and your hips over your knees․ Perform a chin tuck and maintain that head/neck position throughout the exercise․
- Action⁚ Keeping your elbows straight, push into the ground, separating your shoulder blades from each other and moving your chest away from the ground․ This should feel like a coordinated movement, focusing on maintaining your head and neck position while simultaneously moving your shoulder blades․
- Reverse⁚ Slowly reverse the motion, allowing your shoulder blades to come together and your chest to drop towards the ground․
- Repetitions⁚ Repeat this exercise 10-15 times, focusing on proper form and controlled movements․
You may feel a gentle stretch from the bottom of your neck to the base of your skull, and your neck muscles may work to maintain your head position․ If you experience any pain, stop the exercise and consult with your healthcare provider․
First Rib Mobilization
This mobilization technique aims to increase the space between the first rib and the clavicle, thereby relieving pressure on the nerves and blood vessels passing through the thoracic outlet․ It’s important to note that this exercise should be performed with caution and under the guidance of a qualified healthcare professional․
- Position⁚ Sit on a chair with your feet flat on the floor and your back straight․ Place one hand on your chest, just below your collarbone, with your fingers pointing towards your shoulder․
- Action⁚ Gently press down on your chest with your hand, while simultaneously rotating your head towards the opposite side․ You should feel a stretch in the side of your neck and shoulder․ Hold this position for 10-15 seconds․
- Repeat⁚ Repeat this exercise 5-10 times on each side․
During this exercise, you may feel a slight popping or cracking sound, which is normal․ However, if you experience any pain or discomfort, stop the exercise immediately and consult with your healthcare provider․
Scalene Muscle Mobilization
The scalene muscles, located in the neck, play a crucial role in breathing and neck movement․ Tightness in these muscles can contribute to thoracic outlet syndrome by compressing the nerves and blood vessels in the space between the clavicle and the first rib․ This mobilization technique helps to relax these muscles and improve blood flow to the area․
- Position⁚ Sit upright on a chair with your feet flat on the floor and your back straight․ Place one hand on your chest, just below your collarbone, with your fingers pointing towards your shoulder․
- Action⁚ Gently press down on your chest with your hand, while simultaneously tilting your head towards the opposite side․ You should feel a stretch in the side of your neck․ Hold this position for 10-15 seconds․
- Repeat⁚ Repeat this exercise 5-10 times on each side․
During this exercise, you may feel a slight pulling sensation in the side of your neck․ However, if you experience any sharp pain or discomfort, stop the exercise immediately and consult with your healthcare provider․
Ulnar Nerve Gliding
The ulnar nerve, which runs along the inside of the arm and into the pinky finger and ring finger, is often affected in thoracic outlet syndrome․ Ulnar nerve gliding exercises help to improve the nerve’s ability to move freely within its surrounding tissues, reducing pressure and promoting healing․
- Position⁚ Sit upright on a chair with your feet flat on the floor and your back straight․ Extend your affected arm in front of you, with your palm facing up․
- Action⁚ Slowly bend your wrist up towards your body, keeping your fingers straight․ Hold this position for 5 seconds․ Then, slowly bend your wrist down, keeping your fingers straight․ Hold this position for 5 seconds․
- Repeat⁚ Repeat this exercise 10-15 times, making sure to keep your arm relaxed throughout the movement․
You may feel a slight pulling sensation in your arm as you perform this exercise․ If you experience any sharp pain or discomfort, stop the exercise immediately and consult with your healthcare provider․
Radial Nerve Gliding
The radial nerve, which runs along the outside of the arm and into the thumb, index, middle, and half of the ring finger, is another nerve commonly affected by thoracic outlet syndrome․ Radial nerve gliding exercises help to improve the nerve’s ability to move freely within its surrounding tissues, alleviating pressure and promoting healing․
- Position⁚ Sit upright on a chair with your feet flat on the floor and your back straight․ Extend your affected arm in front of you, with your palm facing down․
- Action⁚ Slowly bend your wrist down towards your body, keeping your fingers straight․ Hold this position for 5 seconds․ Then, slowly bend your wrist up, keeping your fingers straight․ Hold this position for 5 seconds․
- Repeat⁚ Repeat this exercise 10-15 times, ensuring to keep your arm relaxed throughout the movement․
You might feel a slight pulling sensation in your arm as you perform this exercise․ If you experience any sharp pain or discomfort, stop the exercise immediately and consult with your healthcare provider․
Median Nerve Gliding
The median nerve, responsible for sensation in the thumb, index, middle, and part of the ring finger, is another common target in thoracic outlet syndrome․ Median nerve gliding exercises aim to improve the nerve’s flexibility and reduce compression, easing symptoms like numbness, tingling, and weakness․
- Position⁚ Sit or stand with your affected arm extended in front of you, palm facing up․
- Action⁚ Make a fist with your hand, then slowly straighten your fingers one at a time, starting with your thumb․ Then, slowly bend your fingers back into a fist, starting with your thumb․
- Repeat⁚ Repeat this exercise 10-15 times, ensuring to keep your arm relaxed and to avoid any sudden or forceful movements․
You may feel a gentle stretch in your forearm and hand as you perform this exercise․ If you experience any sharp pain or discomfort, stop the exercise immediately and consult with your healthcare provider․