• Leung KY
• Chu ECP

• Aged
• Male
• Open Access Document
• Thoracic Outlet Syndrome / therapy

Objective: This study aimed to describe the treatment of a 67-year-old male construction worker diagnosed with arterial thoracic outlet syndrome (aTOS) under chiropractic care, supplemented with thermal imaging findings.

Case presentation: A 67-year-old man presented to a chiropractic clinic with paresthesia in his left medial arm, forearm, and the first to the fourth digits for 4 months, and a colder left forearm and palm. Physical, neurological, and orthopedic examination results demonstrated minimal neurological findings. Adson’s test yielded positive results for the affected arm, and percussion of the supraclavicular fossa recreated the patient’s symptoms. Imaging findings confirmed objectively colder left forearm and palm, and cervical disc degeneration post prominent at C3/4 and C5/6. Based on the results, the working diagnosis of Arterial thoracic outlet syndrome was established.

Intervention and outcome: High-velocity, low-amplitude chiropractic manipulative therapy of the cervical and thoracic spine, scraping therapy, stretching therapy, and lifestyle and postural advice were provided to the patient. Skin peeling, paresthesia, and temperature differences improved after the third week, totaling 7 treatments. Treatment results were maintained at the eight-week follow-up, with only occasional numbness that subsided when stretching was applied to the shoulder and hand. No temperature difference between the palms and arms was observed at follow-up.

Conclusion: Our patient demonstrated an improvement in aTOS under chiropractic care. Chiropractic therapy may play a role in managing aTOS patients. Thermal imaging could be a valuable tool for clinicians when diagnosing arterial based conditions including thoracic outlet syndrome, especially in regions where advanced imaging tools such as computed tomography or magnetic resonance imaging are not available.

Author keywords: vascular thoracic outlet syndrome, cold hand, chiropractic care, arm numbness, manipulation

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