Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 2 - Medical Guidelines › Chapter 22 - Neurological and Neuromuscular Disorder Medical Treatment Guidelines › Subchapter B - Thoracic Outlet Syndrome › Section I-2225 - Therapeutic Procedures-Non-Operative

Current through Register Vol. 50, No. 6, June 20, 2024
A. Initial Treatment Recommendations.
					 Vascular cases will require surgical management and thus are not appropriate
					 candidates for initial non-operative therapy. Cases of "non-specific" (also
					 called disputed) TOS are treated conservatively first for a minimum of three
					 months. Patients undergoing therapeutic procedures may return to modified or
					 restricted duty during their rehabilitation, at the earliest appropriate time.
					 Cessation and/or review of treatment modalities should be undertaken when no
					 further significant subjective or objective improvement in the patient's
					 condition is noted. Most literature of conservative therapy for TOS suggest
					 benefit for patients with non-specific TOS. Non-surgical patients may be less
					 likely to lose as much time from work as surgical patients. Initial treatment
					 for TOS patients without indications for early surgery should include, patient
					 education, jobsite alterations (especially if job activities are related to
					 symptoms), neuromuscular education to emphasis proper breathing techniques and
					 posture, nerve gliding and core body therapeutic exercise.
B. Postural risk factors should be
					 identified. Awkward postures of overhead reach, hyperextension or rotation of
					 the neck, shoulder drooped or forward-flexed and head-chin forward postures
					 should be eliminated. Proper breathing techniques are also part of the
					 treatment plan.
C. Therapy is
					 primarily a daily self-managed home program developed and supervised by an
					 appropriately trained professional. Nerve gliding and upper extremity
					 stretching usually involves the following muscle groups: scalene, pectoralis
					 minor, trapezius and levator scapulae. Endurance or strengthening of the upper
					 extremities early in the course of therapy is not recommended, as this may
					 exacerbate cervical or upper extremity symptoms.
D. Jobsite evaluation should be done early in
					 all non-traumatic cases and should be performed by a qualified individual in
					 all cases of suspected occupational TOS. Postural risk factors discussed above
					 should be considered when making jobsite changes. Unless combined with one of
					 the above postures, repetition alone is not a risk factor. Work activities need
					 to be modified early in treatment to avoid further exposure to risk factors.
1. Acupuncture is an accepted and widely used
					 procedure for the relief of pain and inflammation and there is some scientific
					 evidence to support its use. The exact mode of action is only partially
					 understood. Western medicine literature suggests that acupuncture stimulates
					 the nervous system at the level of the brain, promotes deep relaxation, and
					 affects the release of neurotransmitters. Acupuncture is commonly used as an
					 alternative or in addition to traditional Western pharmaceuticals. While it is
					 commonly used when pain medication is reduced or not tolerated, it may be used
					 as an adjunct to physical rehabilitation and/or surgical intervention to hasten
					 the return of functional activity. Acupuncture should be performed by licensed
					 practitioners.
a. Acupuncture is the
					 insertion and removal of filiform needles to stimulate acupoints (acupuncture
					 points). Needles may be inserted, manipulated and retained for a period of
					 time. Acupuncture can be used to reduce pain, reduce inflammation, increase
					 blood flow, increase range of motion, decrease the side effect of
					 medication-induced nausea, promote relaxation in an anxious patient, and reduce
					 muscle spasm.
i. Indications include joint
					 pain, joint stiffness, soft tissue pain and inflammation, paresthesia,
					 post-surgical pain relief, muscle spasm, and scar tissue pain.