Main Article Content

Eric Chu
King Yi Leung
Lucina Lo Wah Ng
Ada Yuk Yin Lam


Thoracic Outlet Syndrome, Conservative Management


Objective: To discuss the chiropractic management of a patient with vascular thoracic outlet syndrome.

Clinical Features: A 30-year-old male reported sudden onset of intermittent numbness, tightness, and weakness in his right hand. He presented with skin flakes of his right upper limb, cyanosis in the right shoulder; and a cold and pale right hand. Exercise was identified as the provoking motion. Orthopedic examination revealed a positive Allen’s test and modified Adson’s tests. His motor strength of right elbow/wrist flexors and extensors were graded 4/5, and both flexors and abductor of his right 5th metacarpal were significantly weaker than his left. He had been previously diagnosed by a neurologist with arterial thoracic outlet syndrome and prescribed muscle relaxants, physiotherapy exercise, massage therapy, and acupuncture.

Intervention and Outcome: The treatment protocol included spinal manipulative therapy, thermal ultrasonography, instrument-aided soft-tissue mobilization, and extension-compression traction. His symptoms completely resolved, and his repeated orthopedic exams for thoracic outlet syndrome and cervical lordosis were normal.

Conclusion: A 30-year-old male with vascular thoracic outlet syndrome was successfully treated with chiropractic management.


Download data is not yet available.
Abstract 800 | THORACIC OUTLET SYNDROME Downloads 372


1. Jones MR, Prabhakar A, Viswanath O, et al. Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther 2019;8(1):5-18
2. Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. J Vascular Surg 2007;46(3):601-604
3. Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurg2004;55(4):897-903
4. Lo CC, Bukry SA, Alsuleman S, Simon JV. Systematic review: The effectiveness of physical treatments on thoracic outlet syndrome in reducing clinical symptoms. Hong Kong Physiother J 2011;29(2):53-63
5. Qaja E, Honari S, Rhee R. Arterial thoracic outlet syndrome secondary to hypertrophy of the anterior scalene muscle. J Surg Case Rep 2017;2017(8)
6. Thompson JF, Jannsen F. Thoracic outlet syndromes. Br J Surg 1996;83(4):435-436
7. Yuschak E, Haq F, Chase S. A case of venous thoracic outlet syndrome: primary care review of physical exam provocative tests and osteopathic manipulative technique considerations. Cureus 2019;11(6)
8. Povlsen S, Povlsen B. Diagnosing thoracic outlet syndrome: current approaches and future directions. Diagnostics 2018;8(1):21
9. Murphy DR, Hurwitz EL, Gregory A, Clary R. A nonsurgical approach to the management of patients with cervical radiculopathy: a prospective observational cohort study. J Manipulative Physiol Ther 2006;29(4):279-287
10. Chu EC, Chan AK, Lin AF. Pitting oedema in a polio survivor with lumbar radiculopathy complicated disc herniation. J Family Med Prim Care.2019;8(5):1765-1768
11. Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. J Exerc Rehabil 2017;13(1):12-22
12. Chu EC, Lim T, Mak K. Cervical Radiculopathy alleviating by manipulative correction of cervical hypolordosis. J Med Cases 2018;9(5):139-141
13. Berry RH, Oakley P, Harrison DE. Alleviation of radiculopathy by structural rehabilitation of the cervical spine by correcting a lateral head translation posture (-TXH) using Berry translation as a part of CBP Methods. A case report. Chiropr J Australia 2017;45(1):63-72
14. Hooper TL, Denton J, McGalliard MK, Brismée J, Sizer PS Jr. Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis. J Man Manip Ther 2010;18(2):74-83
15. Sanders RJ, Pearce WH. The treatment of thoracic outlet syndrome: A comparison of different operations. J Vasc Surg 1989;1 0(6):626-634
16. Jones MR, Prabhakar A, Viswanath O, et al. Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther 2019;8(1):5-18