The management of thoracic outlet syndrome induced by bilateral cervical ribs in young, female athlete - a case report.

INTRODUCTION: The presence of additional cervical ribs is a rare and relatively unknown pathology. The brachial plexus is most often compressed. Thoracic Outlet Syndrome (TOS) is the one of discussed of mixed compression syndromes, due to diagnostic difficulties and the lack of evidence to resolve the effectiveness of surgical treatment over conservative treatment. CASE REPORT: Presentation of the case of a 22-year-old female athlete with cervical ribs with neurogenic TOS symptoms and presentation of the rehabilitation model and its results. Functional diagnosis included TOS specific clinical tests performed before, immediately after the treatment and one month later. The range of motion (ROM) in the cervical spine, body posture, the pulse on the left and right radial artery, blood pressure on both upper limbs, as well as pain intensity were examined. Management included 8 therapeutic sessions using trigger point therapy, deep tissue massage and cervical rotational manipulations. The maximum muscle relaxation and pain relief (decrease of 3-5 points in VAS) occurred after 5 therapeutic sessions. The rotation and lateral flexion in the cervical spine was significantly improved - the active ROM increased 2,5 in rotation bilaterally and 3,5/4 cm (left/right) in lateral flexion and passive ROM increased 3,5/3 cm (left/right) in rotation and 3.5/4.5 cm (left/right) in lateral flexion. The joint play of the cervical segments was normalized and the result of costo-clavicular test for the right side and the brachial stretch test for the left side become negative while the change of blood pressure in both upper limbs after the therapy as well as after one month was marginal ( ± 1-4 mmHg). CONCLUSION: Conservative treatment based on the therapy of trigger points, deep tissue massage and rotational manipulations of the cervical spine appears to be an effective form of management of TOS induced by additional cervical ribs. However, further studies on are required to determine the most effective treatment options in this condition.