Treatment

Physical Therapy

There are many different therapy options available for TOS and pain relief. It is best to work with a doctor or physical therapist to create the best therapy program for you. Each person is going to need a specialized program. The following is a list of some of the therapies you may want to try:

1. General Physical Therapy
   Working with a therapist to regain your full range-of-motion and building muscle strength. You may also do pain relief techniques such as biofeedback, water therapy, EMS and ENS (described below), or stretching.

2. Postural Therapy
   TOS is aggravated by poor posture. Most general PT’s can work with people on improving their posture to lessen the stress and pressure that is put on the nerves in the brachial plexus (shoulder region). Postural therapy may include techniques like shoulder taping and breathing exercises.

3. Muscle Strengthening
   Start very gently!! Muscle strengthening is very important to give the body better support and stabilization.

4. Nerve Gliding
   TOS can cause severe nerve pain and damage. To keep the nerves moving and free of scarring (especially after surgery), it is crucial to do nerve glide techniques. Nerve gliding should be carefully monitored by a physical therapist or doctor. If done correctly, this technique will help to stretch the nerves and allow them to heal more fully.

5. Stretching
   Allows the muscles to stay looser and helps to prevent pain or injury throughout the body.

6. Massage
   Helps keep muscles loose and may keep pain levels down.

7. Chiropractic
   Manipulation helps keep the spine in alignment preventing other areas of the body to become overstressed. It also can help maintain or improve proper nerve function.

8. Acupuncture
   Can be helpful in relieving pain.

9. Feldenkrais
   Teaches you to improve your posture and move in ways that are pain free.

10. Electronic Muscle Stimulation
    Used to relax tight or tense muscles.

11. Electronic Nerve Stimulation
    Used to relax and calm irritated or inflamed nerves.

12. Ultra-Sound
    Helps loosen tense muscles and calm irritated nerves.

13. Ice/Heat
    Ice is used to decrease inflammation of sore or injured muscles. Heat can also aid in relieving sore muscles.

14. TENS Unit
    Transcutaneous Electrical Nerve Stimulations (TENS) is a safe non-invasive drug-free method of pain management. It relieves pain by sending small electrical impulses through electrodes placed on the skin to underlying nerve fibers. It is a small device that is usually worn on the belt.

15. Edgelow Technique
    This technique is about listening to your body and deciding what you can do each day. The goal is to NOT get flared up. The goal is to STOP before pain starts. To STOP at the first sign of tension. It involves exercises such as: self traction, breathing for relaxation, rib mobilization, use of Styrofoam cylinders to work on spinal mobilization and stability, and aerobic walking.

16. Hyperbaric Oxygen Therapy
    This is not a new therapy, but is new in the area of pain management. While in a hyperbaric chamber, you breath 100% oxygen. The increased oxygen levels at certain depths, can help to repair damaged nerves, muscles, and tissues at a much greater speed, resulting in a faster recovery time.

Injections

There are many different kinds of injections available for pain relief. Here are some examples:

1. Trigger point injections
   Trigger points are hyperirritable bundles of fibers within a muscle, which become "knotted" and inelastic, unable to contract or relax, due to an injury and may cause referred pain. Lidocaine is injected into these points to re- establish a painless, full range of motion.

2. Botox injections
   BOTOX, short for Botulinum Toxin A, works by binding to nerve endings and preventing the release of chemical transmitters that activate muscles. A small amount of Botox is injected into a tight or spastic muscle. The toxin temporarily paralyzes the muscle, forcing it to relax.

3. Stellate Ganglion Blocks
   A needle is injected into the front of the neck and is pushed gently through to just before the spine. Anesthetic is then injected into the ganglion, which is the nerve center for the nerves that feed the face, neck and arm. This numbs the nerves for pain relief. Several treatments may be necessary before the nerves fully respond.

4. Cortisone injections
   Cortisone is injected into a joint, muscle, or tendon for pain relief and to lower inflammation.

Other

There are other options that are fairly new in the world of pain relief, but have been found to be helpful in some cases.

1. Spinal Cord Stimulators/Peripheral Nerve Stimulators
   a small neurostimulation system that is surgically placed under the skin to send mild electrical impulses to the spinal cord. The electrical impulses are delivered through a lead (a special medical wire) that is also surgically placed. These electrical impulses block the signal of pain from reaching the brain. Peripheral nerve stimulation works in a similar way, but the lead is placed on the specific nerve that is causing pain rather than near the spinal cord.

2. Medication Pumps
   A pump is surgically implanted under the skin of a person’s abdomen. A catheter is run to the precise location in the spine where the pain is. Medication can than be pumped directly into the spinal fluid, allowing for a much more potent effect on the spinal cord. This drastically cuts down the dose of medication that is needed, and the medication often provides even better pain relief with much fewer side effects.

3. Nerve Ablation
   Burning nerve endings that are transmitting pain signals. This is a very permanent procedure and is often used as a last resort.

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