Changes in Pain and Duplex Ultrasound Findings Following Four Months of Multimodal Physical Therapy for Thoracic Outlet Syndrome of Pectoralis Minor Etiology: A Case Report

Pectoralis minor syndrome (PMS) involves dynamic compression of the neurovascular bundle in the retropectoral space and can present with neurogenic thoracic outlet syndrome symptoms.This case report describes changes in pain and duplex ultrasound findings in a patient with suspected PMS after four months of multimodal physical therapy.A 28-year-old woman presented with a nine-month history of bilateral medial forearm and little finger pain and tingling.She also reported anterior chest pain, a sense of heaviness after prolonged overhead activity, and pain along the medial scapular border and axilla.She had no history of trauma.She had previously been diagnosed with cubital tunnel syndrome and did not improve with treatment.The Roos test, upper limb neural tension test for median nerve, and hyperabduction test were positive.Tinel's sign at the cubital tunnel and Adson's test were negative.Dynamic duplex ultrasound showed arterial velocity three to four times higher in the provocative position than at rest.She received four months of multimodal physical therapy.It consisted of electrophysical agents, manual therapy, and therapeutic exercises.Electrophysical agents included conventional transcutaneous electrical nerve stimulation, hot packs, and phonophoresis.Manual therapy included myofascial release and thoracic mobilization.Exercises addressed postural correction, cervical core stability, scapular strengthening, and rotator cuff strengthening.Outcomes were the numeric pain rating scale (NPRS) and arterial velocity on dynamic duplex ultrasound.At the end of treatment, NPRS decreased from 9/10 to 2/10, and arterial velocity decreased from 178 to 107 cm/s on the left and from 195 to 122 cm/s on the right in the provocative position.She returned to work without limitations.This case suggests that a criteria-based multimodal physical therapy program may be a useful option for patients with thoracic outlet syndrome.However, this is a single uncontrolled case with multiple interventions, so causality cannot be established.Prospective studies are needed.