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What is the best treatment for thoracic outlet syndrome other than physiotherapy?

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Orthopaedic Surgeon
Practicing since : 1994
Answered : 9077 Questions
Hello Doctor, The following is a query for my brother, who is facing severe pain on and off. Please suggest the best advice from your side. -------------------------------------------------------------------------------------------------------------------------------------------------- Hello Doctor I am having pain in left side of the neck, left hand, arm, shoulder with numbness since 1 month, the numbness along with severe pain will be radiating from the shoulder till palm. Frequency of this pain occurs in 1 to 2 minutes. During night times it will be more and will not be able to sleep properly. I have consulted a Doctor who after hearing my symptoms told that I have thoracic outlet syndrome, and suggested to take physiotherapy. I took 15 sessions but no improvement. Kindly suggest which type of specialists I should approach and good doctor for this kind of problem. Also I had back pain for 3 to 4 years which I am keeping it away by doing strengthening exercise. I have done complete spine scan and I am attaching the report here. Thanks in advance. Regards XXXXXXX
Posted Sun, 22 Dec 2013 in Bones, Muscles and Joints
Answered by Dr. Praveen Tayal 20 hours later
Brief Answer: Consult a neurologist. Detailed Answer: Hello, Thanks for posting your query. I have seen the report attached. There are early spondylottic changes in the cervical spine. These are not likely to cause the severe symptoms like your brother is having. The symptoms are likely to be due to thoracic outlet syndrome. It is a group of disorders that occur when the blood vessels or nerves in the thoracic outlet — the space between the collarbone and the first rib — becomes compressed. Cervical rib is one of the cause. This can cause pain in the shoulders and neck with numbness. In this overhead activities are particullary difficult because they worsen the compression of brachial plexus and blood vessels. In most cases, a conservative approach to treatment is effective. Your brother has to learn how to do exercises that strengthen the shoulder muscles to open the thoracic outlet, improve the range of motion and improve the posture. These exercises, done over time, will take the pressure off the blood vessels and nerves in the thoracic outlet. In general, avoid unnecessary stress on the shoulders and muscles surrounding the thoracic outlet by - Maintain good posture Take frequent breaks at work Practice relaxation techniques I suggest him to consult a neurologist for thorough examination. He may prescribe pain medications, muscle relaxants, methylcobalamin supplements and anti-inflammatory drugs — aspirin or ibuprofen (Advil, Motrin, others) — to decrease inflammation and encourage muscle relaxation. I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal.
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Follow-up: What is the best treatment for thoracic outlet syndrome other than physiotherapy? 1 hour later
Hello Dr. XXXXXXX Tayal Thanks for your detailed reply and information. My brother had first met a Neurologist only and a NCS (Nerve conduction test) was carried out for both hands and the report was normal. Subsequently, the doctor had suggested for Physiotherapy but the problem is the fluctuating response/recovery of his body for this treatment based on the person doing it (it has not been same person doing it). The Physiotherapist had prescribed Amitriptyline, ultracet & celadrin medicines. Can you please let us know your opinion on these medicines and further, if any other tests are to be done? Also, as right physiotherapy is very essential for cure this problem, can you please suggest a good physiotherapist (or) good physiotherapy clinics in Bangalore. Thanks in Advance, Regards, XXXXXXX
Answered by Dr. Praveen Tayal 36 minutes later
Brief Answer: Do get the prescriptions from neurologist. Detailed Answer: Hello. Thanks for writing again. The medicines that are required should be prescribed by a neurologist rather than a physiotherapist. These medicines do need a careful dose regulation and will not help much in decreasing the actual pathology. These are pain killers and mood elevators. There is no muscle relaxant or methylcobalamin prescribed which will be better under these circumstances. It is best to get the recommendations regarding the physiotherapist most suitable for you from your neurologist who can guide the physiotherapist regarding the type of exercises needed. Hope my answer is helpful. If you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health. Regards
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