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.
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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.
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