Thoracic outlet syndrome pillow9/24/2023 ![]() ![]() 20 These patients are instructed in the Cyriax release technique ( Fig. The presence of a ‘release phenomenon,’ with paresthesias, numbness, or pain that wakes the patient during the night, may be confirmed with the Cyriax release test. Pillows may be placed under each arm when lying supine or between the body and the involved upper extremity when on lying on the side. The patient should sleep on the uninvolved side and avoid lying prone. 18 If position dependent, then patients who cannot avoid the provocative position during the night may benefit from pinning the sleeve of the pajama arm to the pajama leg. Others 17 have found that a three-week course of mechanical cervical traction along with a hot pack and exercise program reduced complaints of numbness significantly more than hot pack and exercise alone.ĭisturbed sleep patterns are common in many people suffering from TOS, often as a result of either sleeping with the arms in an abducted, overhead position, or the consequence of the ‘release phenomenon’. 15 found that 64% of subjects had a minimum of 50% decrease in pain, numbness, and fatigue for at least one month following injection. ![]() 9 Injection of botulinum toxin into the anterior and middle scalenes for temporary relieve of pain and spasm resulting from neurovascular compression in the thoracic outlet has also been investigated. Nonsteroidal anti-inflammatory drugs may be prescribed to reduce pain and inflammation. 14 Attempts to correct postural or biomechanical abnormalities prior to efforts at pain relief could result in an increase in symptoms and should therefore be approached cautiously in the initial treatment stages. The major focus of early treatment efforts should be symptom reduction. Management of these complex patients requires an individualized approach to the patient and his or her particular symptoms. Many sufferers of TOS have a long history of pain and disability. 13 found that poor outcome to conservative therapy was associated with obesity, worker’s compensation, and double crush pathology involving the carpal or cubital tunnels. A recent review of 13 studies published between 19 found that good or very good results were achieved in 76 to 100% of disputed neurogenic TOS patients at short-term follow-up (within a month) and 59 to 88% after at least one year. 5 – 11 A majority of patients with neurogenic TOS can be expected to improve with proper conservative treatment. Although controversy exits regarding the optimal treatment approach for these patients, conservative measures should be attempted for patients with disputed neurogenic TOS before surgery is considered. After a thorough clinical examination is performed and the underlying cause(s) of the patient’s symptoms are identified, attention can be turned toward treatment of the patient’s TOS.
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