Post operative physiotherapy after first rib resection for thoracic outlet syndrome

Report By: Isabel Hole and Stephanie Pirrazzo - Physiotherapist
Search checked by Isabel Hole - Physiotherapist
Institution: Manchester Royal Infirmary
Date Submitted: 20th March 2020
Last Modified: 20th March 2020
Status: Blue (submitted but not checked)

Three Part Question

In [adults following first rib resection surgery] is [physiotherapy] beneficial at [increasing function]?

Clinical Scenario

You are a physiotherapist working on a vascular ward. A 30 year-old female is admitted to the ward after first rib resection surgery with no complications intra-operatively. Post-operative instructions request day 1 intensive physiotherapy input but no guidance has been given. What acute postoperative physiotherapy exercises should be provided for optimum recovery?

Search Strategy

CINAHL 25/02/2020 1/25 result
BNI 05/03/2020 0/20 results
EMBASE 05/03/2020 1/22 result
MEDLINE 14/03/2020 1/24 results
AMED 15/03/2020 0/24 results
PubMed 15/03/2020 3/19 results
Cochrane Library 19/03/2020 0/7 results
Additionally 2 other articles were identified from searches of reference lists of relevant articles
(thoracic outlet syndrome OR first rib resection OR scalenectomy OR thoracic outlet decompression) AND (physiotherapy OR physical therapy OR exercise OR rehabilitation) AND (range of movement OR range of motion OR recovery OR activities of daily living). Limits- English

Search Outcome

A total of 7 papers were found using the search terms. However, following review, all papers were deemed irrelevant. These papers outlined surgical outcomes rather than the physiotherapy post-operative protocol. Studies suggested range of movement exercises and gentle strengthening exercises being beneficial to prevent scar tissue formation.

Comment(s)

There is no literature on physiotherapy intervention following first rib resection for thoracic outlet syndrome.

Clinical Bottom Line

There is a lack of research into best practice for post-operative physiotherapy following first rib resection therefore further research is needed. Local advice should be followed.