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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.


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