Thoracic Outlet

S: Pt. came to the athletic training room after a long threshold swimming practice complaining of numbness
in both hands. There is no known MOI. The pt. mentions he has been dealing with similar symptoms for
close to 10 years, but recently the symptoms have been increasingly interfering with his swimming. The
numbness has forced him to only kick towards the end of practices. In the past, signs resolved within 30 mins
after the end of activity, but the time has recently increased to 60 mins or more. Previous self-treatment has
included stretching and foam rolling. The pt. has never been evaluated by a medical professional for this
problem. Pt. denies any history of shoulder/neck pathology.
O: Upon observation there was no obvious deformity/asymmetry. Upon palpation there was muscle
tightness over both sides of the upper trapezius.
AROM PROM and RROM: WNL and PL
(+) Adsons, Allens, Roos Test (-) Brachial Plexus stretch test, Spurling test
Neurological exam was WNL
A: Pt. has thoracic outlet syndrome
STG: Reduce time to presentation of symptoms LTG: Return to full symptom free participation
P: Implement the use of modalities to reduce symptoms: combo, Graston, STM, and stretching. Begin
NSAIDs as directed. If symptoms persist, a physician f/u will be required. Continue to monitor for changes.
-Alice Jose, ATS
2.3.14
5:25pm
S: Pt. symptoms continue to persist but are not getting worse.
O: Pt. is able to get through practice but still needs daily treatment.
A: STG: Determine cause of compression in the thoracic outlet through appointment with physician. LTG:
Control symptoms so the pt. can participate in the Mens Big Ten Swimming Championship.
P: Make referral for testing. Continue with treatment.
-Alice Jose, ATS
2.10.14
5:15pm
S: Pt. went to Premier Ortho for Doppler Test (US), a simple, noninvasive blood pressure measurement at
various positions on the arm.
O: Doppler findings were abnormal.
A: STG: Determine the location causing the abnormality. LTG: Control symptoms so the pt. can participate in
the Mens Big Ten Swimming Championship.
P: Make referral for CT angiogram. Continue with treatment. Have pt. kick during practice if symptoms
present themselves.
-Alice Jose, ATS
2.13.14
2:45pm
S: Pt. went to the Bloomington Hospital for CT angiogram to determine location of thoracic outlet
compression.
O: The CT angiogram was normal.
A: The negative CT angiogram confirms a diagnosis of the Thoracic Outlet due to 1
st
rib compression. No
stenosis.
P: Pt. begins tapering for the Big Ten Championship next week. The pt. will limit activity in practice to kicking
and will begin postural muscle strengthening as well as scalene stretching when he returns.
-Alice Jose, ATS
2.20.14
9:15am

CIP-9
Code Description Medical Payment
1 76827
Doppler echocardiography, fetal, pulsed wave and/or continuous
wave with spectral display; complete
71.75
2 75574
Computed tomographic angiography, heart, coronary arteries and
bypass grafts (when present), with contrast material, including 3D
image postprocessing (including evaluation of cardiac structure
and morphology, assessment of cardiac function, and evaluation
of venous structures, if performed)
396.44