Manual Therapy and Upper Quarter Training in an Adolescent Quarterback with Chronic Clinically Suspected Thoracic Outlet Syndrome: A Case Report with 1-Year Follow Up

Background: The brachial plexus neurovascular bundle has been described as a pain generating entity in the upper quarter. Many factors contribute to neurovascular irritability, not least of which shoulder girdle mobility dysfunctions, particularly in the throwing athlete. Methods: This case study describes clinical identification of upper quarter impairments contributing to a suspected disputed neurogenic thoracic Outlet Syndrome (TOS) in a high school quarterback. Specific clinical examination using provocation, mobility, upper quarter dynamic control, and functional outcome measures led to directed interventions. Results: Reported symptom resolution began after 3 sessions and functional control was restored by the 10th session. Improvements remained at 1-year follow up. Conclusion: While clinical causation cannot be inferred from a single subject case report, these outcomes are indicative of how shoulder girdle mobility and dynamic control impairments may contribute to brachial plexus irritability in a throwing athlete. Moreover, these specific interventions may be useful in other patients with similar impairments.