Hi Justin,
TOS can be a frustrating thing to work with, especially considering the lack of great evidence to guide our assessment and treatment, as well as the poor special tests we have to identify these issues. We will talk about this some in Weekend 3, but the majority of these cases are considered disputed neurogenic TOS (90+%) and have (-) diagnostic testing. True vascular, arterial, or neurogenic, only accounts for < 10% of these cases – and they will have (+) testing/imaging. Successful treatment of these folks is really an exercise in anatomy and understanding where the inferior portion the plexus can be restricted, what adjacent structures could promote this dysfunction (thoracic spine, CT junction, 1st/2nd rib, posterior capsule of shoulder, pec, AC/SC joint, etc), and having procedures to assess this – ULPT 3, for example. I would recommend approaching this the same as you approach other patients – identify objective impairments, have solid objective *, treat an area, and reassess that area, as well as others to determine what type of carry over you have, if any. Here is a nice series that Phil Sizer put out a couple of years about that has a helpful table about how to structure treatment pending their response to our objective testing. Hope this helps.
Aaron
VOMPTI
Virginia Orthopaedic Manual Physical Therapy Institute
