Physical assessment and rehabilitation for neurogenic thoracic outlet syndrome (NTOS): A scoping review

Neurogenic Thoracic Outlet Syndrome (NTOS) is a complex condition that can be encountered in musculoskeletal and hand therapy services. Rehabilitation is recognised as the primary treatment for NTOS however, detail on rehabilitation components are poorly described. This scoping review aimed to identify and describe the physical assessment and rehabilitation components alongside clinical reasoning strategies that may aid therapists in the conservative management of adults with NTOS.

Four databases (MEDLINE, EMBASE, CINAHL and Cochrane) were searched, utilising the PRISMA-ScR guidelines. The Template for Intervention Description and Replication (TIDieR) checklist was used to organise data regarding rehabilitation interventions for NTOS.

Twenty-Nine out of 1381 studies identified, met the eligibility criteria. NTOS Provocation tests (16/18 89%) were the most frequently described assessment components, followed by palpation of pertinent structures (11/18 61%) and assessment of posture (10/18 56%). 'Decompressing the thoracic outlet' was the main aim encountered for rehabilitation programmes. Exercise (17/19 90%) was the most frequent rehabilitation intervention identified, with stretching (n = 15), strengthening (n = 14) and neural mobility (n = 7) exercises being most prevalent. The Scalenes and Pectoralis muscles (n = 10) were the main targets for stretching whilst the Scapula (n = 9), Trapezius and Serratus Anterior muscles (n = 5) were the main targets for strengthening exercises. Other interventions identified included, posture improvement (n = 13), manual therapy (n = 10), adjuncts (n = 8) and activity modification (n = 7).

The reporting of rehabilitation techniques for NTOS is generally poor, particularly regarding treatment intensity. There is an essential need for a standardised and reproducible rehabilitation intervention for NTOS to be developed.