Masterclass Thoracic 4 May 2024

Thoracic Outlet Syndrome

Lecturer: Thomas Mitchell

Tos lecture
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SUMMARY

The masterclass is a detailed presentation by Thomas Mitchell on thoracic outlet syndrome (TOS), a complex condition involving neurovascular compression in the thoracic outlet, which is the space between the clavicle and the first rib. Mitchell explains that TOS is difficult to diagnose due to its vague symptoms, such as pain in the neck, shoulder, or arm, and tingling or numbness. He highlights the different types of TOS—neural, venous, and arterial—with neural being the most common. The masterclass includes epidemiological data, potential causes, symptoms, and an overview of diagnostic methods, emphasizing the use of clinical expertise and various tests like Adson’s and EAST tests to identify TOS. Mitchell also stresses the importance of considering differential diagnoses, such as other neurogenic, vascular, and systemic conditions.

In the second part of the masterclass, Mitchell discusses treatment options for TOS, which may include physiotherapy, manual therapy, and in some cases, surgery. He presents a case study of a patient with disputed neurogenic TOS, highlighting the challenges of diagnosis and management. Mitchell concludes by discussing the philosophical debate on whether TOS is a diagnosis of exclusion and emphasizes the importance of shared decision-making and ongoing management with patients. He concludes by recommending resources and further learning opportunities, such as those provided by the Thoracic Outlet Syndrome Centre of Excellence.

LECTURER

Thomas is a wrist and hand specialist physiotherapist, and working toward his PhD at Sheffield Hallam. He is a physiotherapist of 25 years standing in primary care, private practice and sports. He is a First-contact Practitioner clinical supervisor and member of the British Association of Hand Therapists. He is also a Member of the Mulligan Concept Teachers Association.

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