the study was done to: To assess the effect of Mechanically Loaded Neuro-dynamics on pain reduction in subjects with thoracic outlet syndrome. To assess the effect of Mechanically Loaded Neuro-dynamics on shoulder range of motion in subjects with thoracic outlet syndrome. To assess the effect of Mechanically Loaded Neuro-dynamics on clinical provocative tests in subjects with thoracic outlet syndrome. To assess the effect of Mechanically Loaded Neuro-dynamics on neurophysiological findings in subjects with thoracic outlet syndrome. To assess the effect of Mechanically Loaded Neuro-dynamics on quality of life and psychological status in subjects with thoracic outlet syndrome.
Thoracic outlet syndrome (TOS) involves symptoms from the compression of neurovascular structures at three key sites: the costoclavicular junction, scalene triangle, and pectoralis minor space. It is categorized into three types: neurogenic Thoracic outlet syndrome, arterial Thoracic outlet syndrome, and venous Thoracic outlet syndrome, with neurogenic Thoracic outlet syndrome being the most common. Management typically involves conservative methods such as exercise rehabilitation, which aims to relieve symptoms by increasing thoracic outlet space. However, current literature lacks comprehensive reviews on exercise protocols. Mechanical loaded neuro-dynamics is introduced as a promising rehabilitation approach for athletes, focusing on enhancing neural and vascular mobility through controlled loading. Provocative tests are crucial for diagnosing Thoracic outlet syndrome , targeting the specific mechanisms of compression. Additionally, electro-neuro-graphical examinations play a vital role in diagnosing neurogenic Thoracic outlet syndrome by revealing abnormalities in nerve impulse transmission.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
36
Physical therapy management will include 11 visits over 11 weeks, utilizing green medium-resistance bands (4.6-6.9 pounds at 100% elongation). The protocol involves: weeks 3-4 with low tension isometric holds (5-10 seconds) in partial range; weeks 5-7 with dynamic repetitions (10-15 repetitions, 3 sets) in full range; and weeks 8-11 featuring sport-specific load progression with cycling postures and upper extremity tasks. Repetitions will be slow and controlled, with cues to minimize guarding or Valsalva. Progression will depend on symptom response and visual analogue scale scores, with Mechanically Loaded Neuro-dynamics performed 1-2 times weekly in-clinic and daily home exercises.
traditional physical therapy program
out-patient clinic, faculty of physical therapy - Kafrelsheikh University.
Kafr ash Shaykh, Egypt
assessment of Active and passive Range of motion
Cervical spine range of motion (ROM) was assessed using a goniometer. Participants were positioned comfortably in a standardized sitting position, with the trunk stabilized to minimize compensatory movements. Cervical flexion, extension, lateral flexion, and rotation were measured in degrees. The goniometer was aligned according to standard anatomical landmarks for each movement, and the active ROM was recorded at the end of the available pain-free range. Measurements were performed consistently for all participants under the same testing conditions.
Time frame: At baseline and after 11 weeks
assessment of sensory nerve conduction velocity
For the digital sensory nerve conduction study, we will use standard antidromic techniques with a fixed distance of 11 cm between the recording and stimulating electrodes for the ulnar and 13 cm for the median sensory nerves. Standard techniques and distances between recording and stimulating electrodes will be used for the medial antebrachial cutaneous (12 cm), lateral antebrachial cutaneous (12 cm), and the dorsal ulnar cutaneous (8 cm) nerve conduction study. Sensory nerve conduction study parameters included sensory nerve action potential, amplitude and peak latency
Time frame: At baseline and after 11 weeks
assessment of motor nerve conduction velocity
For motor nerve conduction study, also will be used a fixed distance of 7 cm between the recording and stimulating electrodes for both median and ulnar nerves. motor nerve conduction study parameters included compound muscle action potential amplitude, area, distal latency, duration of the negative phase, and forearm conduction velocity.
Time frame: At baseline and after 11 weeks
assessment of physical function and symptoms of the upper limb
The Disabilities of the Arm, Shoulder and Hand is a 30-item instrument assessing health status in daily activities, symptoms, social functioning, and psychological factors over the past week. Responses range from 1 (no difficulty) to 5 (unable to perform), yielding scores from 0 to 100, where higher scores indicate greater disability. The he Disabilities of the Arm, Shoulder and Hand demonstrates strong reliability, with an intraclass correlation coefficient of 0.74-0.95. The minimum detectable change is 11 points, while the minimum clinically important difference is 10.83 points, indicating significant changes in patient function.
Time frame: At baseline and after 11 weeks
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