Occupational Therapy Treatment for NTOS
When treating patients with neurogenic thoracic outlet syndrome (NTOS), the focus of occupational therapy (OT) is to decrease the impact of symptoms on daily activities, teach proper body mechanics and/or compensatory positioning, and prevent symptoms fro
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Dana Emery
Abstract
When treating patients with neurogenic thoracic outlet syndrome (NTOS), the focus of occupational therapy (OT) is to decrease the impact of symptoms on daily activities, teach proper body mechanics and/or compensatory positioning, and prevent symptoms from further impacting the patient’s life. OT can be used as the primary treatment for NTOS or as a part of the postoperative recovery process in patients who have undergone thoracic outlet decompression. A key to the alleviation of symptoms and an increase in recovery speed is teaching surgical and non-surgical patients to maintain appropriate posture while performing everyday activities. Providing the patient with information and skills needed regarding the positions that will close off the outlet and potentially increase symptoms and pain will aid the patient in independence in symptom management. Specific maneuvers include the avoidance of compression at the shoulder, side-lying sleep position, and the avoidance of prolonged or repetitive overhead arm use.
Introduction
Treatment Setting
When treating patients with neurogenic thoracic outlet syndrome (NTOS), the focus of occupational therapy (OT) is to decrease the impact of symptoms on daily activities, teach body proper mechanics and/or compensatory positioning, and prevent symptoms from further impacting the patient’s life [1].
An occupational therapist’s practice in a multidisciplinary clinic setting can be crucial to patient outcomes. This approach involves the collaborative efforts of the physician, nurse practitioner, and occupational therapist to guide the appropriate level of intervention for each patient. The occupational therapist participates in assessment of patients by performing examinations that provide important information for OT treatment planning. These tests include an assessment of function in daily activities, grip and pinch testing [2–4], sensory screening [5–7], and an evaluation of a patient’s tolerance to peripheral nerve glides [8–12]. This assessment, in
D. Emery, OT/L, BS Department of Occupational Therapy, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA e-mail: [email protected]
K.A. Illig et al. (eds.), Thoracic Outlet Syndrome, DOI 10.1007/978-1-4471-4366-6_24, © Springer-Verlag London 2013
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conjunction with the standard provocative testing for TOS [13, 14], will assist the team in understanding the area of compression, severity of symptoms or rule out TOS all together. In a specialized outpatient OT clinic, the therapist is able to be more detailed in their assessment of patients. This setting may identify patients with symptoms of TOS that have not yet seen a vascular surgeon; they may have been referred from a primary care physician or other discipline due to pain or dysfunction in daily activities, or job performance [15].
Primary Therapy for NTOS For selected patients who do not require immediate surgery, the team may opt for a trial of OT before committing to a surgical approach. The goal
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