(Kiosk 2) Postural Thoracic Outlet Syndrome – Monitoring Progress with Upper Extremity Functional Index Scores: A Case Report

Case Diagnosis: Thoracic Outlet Syndrome (TOS) is a lower trunk plexopathy due to vascular or neurogenic etiologies. A lesser-known etiology, Postural Thoracic Outlet Syndrome (PTOS), is a more appropriate diagnosis when there is not objectifiable neurologic or vascular abnormalities. In PTOS, compression of Brachial Plexus (BP) due to a shortened pectoral minor muscle (PMM) is secondary to overly protracted shoulders. There is a limited amount in the current literature that outlines the treatment of PMM or how to track the progression of rehabilitation.

Case Description or Program Description: 32-year-old transgender male with history of Ehlers Danlos Syndrome, MDD, and ADHD was referred to our clinic for right sided neck pain with associated paresthesia and weakness in his right hand. Surgical history includes bilateral mastectomy. Previous work up included right shoulder arthrogram, electromyography of right upper extremity, and cervical MRI that were all negative. Treatment included multiple trigger point injections (TPI) in neck and shoulder girdle, osteopathic manipulative treatment (OMT) and physical therapy without improvement of symptoms. During NMUS evaluation, PMM bowing with movement was noted. A diagnostic TPI to the PMM was completed and revealed subjective improvement of symptoms. The patient was instructed to return to PT to focus on postural training and pectoral stretching. The treatment course then included 25 units of Botox to PMM. A Pre & 6-month post treatment upper extremity functional index (UEFI) was obtained.

Setting: Outpatient

Assessment/Results: Pre-procedure UEFI: 57, Post-procedure UEFI: pending

Discussion (relevance): It is pivotal to identify PMM compression of BP on NMUS with maneuvers because static testing for both Vascular and Neurogenic TOS etiologies will be negative. After diagnosis, functional scoring and reassessment with NMUS can be used to track progress objectively.

Conclusions: This patient’s PTOS diagnosis required NMUS to identify PMM compression of BP. Tracking functional index scoring can allow practitioners to monitor progress.