Monday, 16 January 2017

Diagnosis and Physiotherapy for Thoracic Outlet Syndrome

Roo’s test has a better sensitivity for provoking symptoms of thoracic outlet syndrome. This test requires the patient to adapt the “surrender position”, which involves hyperabduction and external rotation of the arm. The patient is instructed to open and close the hands for 1-3 minutes with the elbow bent and arms abducted to 90 degrees and externally rotated to compress the neurovascular structures and provoke the symptoms. The shoulder blades need to be evaluated to check for abnormal movement and position of the scapular.

Learn more about thoracic outlet syndrome. https://www.mychiro.com.my/joint-and-sports-injury/thoracic-outlet-syndrome/

The site of compression of the thoracic outlet syndrome changes the main focus of the treatment. 
However, there are a few treatments that are suitable for most of the cases of TOS. The health practitioner should correct the drooping shoulders, poor posture and poor body mechanics of the patient by teaching them proper positioning while sitting, standing and lying down. 

Manual therapy such as stretching, trigger point therapy, soft tissue mobilization, scapular mobilization and scapula-thoracic mobilization can be used to address tight muscles and restricted tissues. Restoration of the accessory motion at the sternoclavicular and acromioclavicular joints can be achieved by mobilization of the first rib. Side-bending and chin-tuck exercises help to stretch the soft tissues of the neck and strengthen the deep neck muscles. These exercises can correct anterior head carriage. Thoracic extension and brachial plexus stretching exercises can be given to reduce the tension in the muscles and neural structures.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Wednesday, 11 January 2017

The Diagnosis of Thoracic Outlet Syndrome

People with thoracic outlet syndrome (TOS) often present with signs and symptoms that result from the compression of the neurovascular structures that travels from the neck to the axilla. They can present with pure arterial, venous or neurogenic picture, however, most health practitioners encounter TOS with a mixed presentation. Signs and symptoms of TOS include, but not limited to, neck pain, shoulder pain, numbness and tingling in the upper limb, weakness in the upper limb, and coldness in the upper limb.

Learn more about thoracic outlet syndrome. https://www.mychiro.com.my/joint-and-sports-injury/thoracic-outlet-syndrome/

People with a chronic abnormal movement of the shoulder blade are more susceptible to thoracic outlet syndrome. The tightness of the pectoralis minor, scalene and upper trapezius muscle combined with weakness in serratus anterior and lower trapezius can cause excessive anterior tilting and protraction of the shoulder blade. This can cause further compression of the neurovascular structures in the thoracic outlet.

Adson’s test is used to assist the diagnosis of arterial compression in thoracic outlet syndrome. The patient is asked to rotate the head and neck towards the affected side and extend the neck. The practitioner can check for a diminished radial pulse while the practitioner passively abducts, externally rotates and extends the arm of the patient. The patient can take a deep breath and hold it in to further increase the arterial compression at the thoracic outlet. Reproduction of the symptoms with diminished radial pulse indicates positive sign for Adson’s test.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Friday, 6 January 2017

Common Causes of Thoracic Outlet Syndrome


Thoracic outlet syndrome is a group of conditions that involves pain, numbness or tingling sensation in the neck and/or upper limb as a result of compression of the neurovascular structures. This condition is very common in athletes that are actively involved in overhead sports. People with poor posture such as drooping shoulders are more susceptible to thoracic outlet syndrome as the diameter of the cervicoaxillary canal is reduced. Congenital abnormalities of the structures in the neck can compress the neurovascular structures in the thoracic outlet and result in signs and symptoms in the neck and the upper limb. Complete cervical rib, incomplete cervical rib with fibrous band, fibrous band from the transverse process of the lower cervical segments and clavicular abnormalities are a few of the congenital abnormalities that can cause neurovascular compression at the thoracic outlet.


Cervical ribs can present just on one side but are more commonly found on both sides when present. However, not everyone with cervical ribs have signs and symptoms of thoracic outlet syndrome. In fact, only about 10% of patients with cervical ribs have signs and symptoms of thoracic outlet syndrome. Shortening and tightening of the scalene muscles due to active trigger point can result in thoracic outlet syndrome. Patients with fractured first rib or clavicle, psudoarthrosis of the clavicle, malunion of clavicular fractures, callus formation or crush injury to the upper thorax are at a higher risk of developing thoracic outlet syndrome.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Sunday, 1 January 2017

Thoracic Outlet Syndrome with Chiropractic Care and Physiotherapy


Patients with thoracic outlet syndrome (TOS) often present with neck or shoulder pain, numbness or tingling that affects the entire or part of the upper limb, and weakness in the arm. Sometimes patients may complain of coolness or venous engorgement of the affected arm. Patient with TOS often complained of signs and symptoms that result from irritation of the artery, venous, neural structures or a combination of the structures above.


Thoracic outlet syndrome is a group of conditions due to compression of the neurovascular structures that run from the neck to the axilla through the thoracic outlet. The brachial plexus and subclavian vessels are most commonly being compressed as these structures are located very close to each other in the thoracic outlet. These neurovascular structures are most commonly being compressed at the costoclavicular space which is located between the clavicle and the first rib. This is commonly known as the costoclavicular syndrome.

Another common site of compression is the space between the anterior scalene muscle, the middle scalene muscle and the upper border of the first rib. This is usually known as the anterior scalene syndrome. Hyperabduction syndrome or pectoralis minor syndrome involves the compression of the neurovascular structures at the space between the coracoid process and the pectoralis minor insertion.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Monday, 26 December 2016

Chiropractic View on Rehabilitation Exercises for Scoliosis

Adolescent idiopathic scoliosis is a complex spinal deformity that involves lateral deviation, twisting of the spine and decreased sagittal spinal curvature. Over the past few decades, rehabilitation exercises have been part of the treatment program to manage and prevent the progression of the scoliotic curve. Recent research suggested that the development of postural deviation originates from a dysfunctional interaction between the central nervous system and body biomechanics.

Learn more about non-surgical scoliosis treatment. https://www.mychiro.com.my/spine/scoliosis/scoliosis-treatment/

There are two main exercise approaches which are based on two different hypothesis for the development of scoliosis. The neurophysiological approach is developed based on the hypothesis that adolescent idiopathic scoliosis has a major central nervous system dysfunction. The other approach, namely the biomechanical approach, were founded on the theory that adolescent idiopathic scoliosis originates from a muscular imbalance. However, recent research showed that both central nervous system dysfunction and muscular imbalance contribute to the development and progression of scoliosis. Therefore, both approaches need to be included in the rehabilitation program in order to achieve better results.

Understanding of the neural mechanisms of the motor and postural control and their interactions with body biomechanics and with cognitive systems is important in facilitating the rehabilitation exercise program for scoliosis. Mapping of the spatial coordinates and body awareness is a main role of the cognitive systems. All of the above-mentioned fields need to be explored and keep in mind while planning an effective rehabilitation exercise program for scoliosis.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Wednesday, 21 December 2016

Chiropractic and Scoliosis in Children

Adolescent idiopathic scoliosis (AIS) is one of the most common causes of spinal deformity in adolescents. AIS have the most significant impact on adolescent undergoing their rapid growth period. Adolescent idiopathic scoliosis is characterized by a lateral deviation, axial rotation and reduction of sagittal curvatures of the spine that develops during growth. Girls have a higher risk of developing AIS and they are more likely to develop severe scoliosis with Cobb angle measured more than 30 degrees. AIS can lead to physical deformity, psychological issues, biomechanical impairment, neuromotor deficit, and cardiorespiratory dysfunction.

Learn more about scoliosis. https://www.mychiro.com.my/spine/scoliosis/

Over the years, research has demonstrated a few factors that may contribute to the development and progression of AIS. The main factors include defective central nervous system control of the body posture, alteration of body schema, abnormal interaction between hormones involved in the growth processes such as melatonin and growth hormone, genetic factors leading to cell membrane defects affecting collagen and skeletal muscles, and biomechanical issues of the spine. Adolescents with a strong family history of idiopathic scoliosis are at high risk of developing a severe scoliotic curvature.

There are two main treatments available for AIS, conservative treatment and surgical option. Conservative treatment should be exhausted before surgical approach is required. In scoliosis with Cobb angle less than 30 degrees, conservative management including physiotherapy, chiropractic treatment and extensive rehabilitation exercise program can be introduced to manage the scoliosis. This main goal of this initial conservative treatment is to prevent rapid deterioration of the scoliotic curve and the need for spinal fusion surgery. If conservative treatment fails, surgery will be the other option.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my



Friday, 16 December 2016

Chiropractic and Middle Back Pain

People with mid back pain normally present with pain between or around the shoulder blades. The pain can be in the middle, on the left or right side, or on both sides. A sudden movement to the thoracic spine may have triggered the pain or the pain may have commenced gradually over a period time. Twisting and turning or side bending of the spine usually will aggravate the thoracic pain. Numbness or pins and needles along the rib cage at the affected level may be reported. Signs and symptoms along the dermatomal distribution are more predictable in the thoracic area, however, symptoms may vary in certain cases.

Learn more about back pain. https://www.mychiro.com.my/spine/back-pain/

Injury to the adjacent cervico-thoracic spine may refer pain to the shoulder area. The lower thoracic region cannot be overlooked in patients with buttock, hip or inguinal symptoms. The internal organs that lie in close proximity with the thoracic spine must be checked as these organs are capable of referring pain to the spinal region mimicking a mechanical spine injury.

The range of motion and mobility of the intervertebral segments in the thoracic spine should be carefully assessed. The paraspinal and periscapular muscles should be examined for tightness, trigger points and weakness. The lower cervical and upper lumbar spine should be included in the physical examination due to its close proximity to the thoracic spine. Neurological examinations of the spine can be performed to rule out neural structure damage.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my