Effects of an Integrated Postural Training Program on Pain, Grip Strength, and Upper Limb Nerve Tension in Patients With Neurogenic Thoracic Outlet Syndrome: A Prospective Comparative Study.

BACKGROUND

Neurogenic thoracic outlet syndrome (nTOS) is a prevalent shoulder girdle disorder characterized by upper extremity pain, numbness, and motor weakness caused by mechanical compression of the brachial plexus. Faulty postural alignment, such as forward head posture and rounded shoulders, narrows the anatomical pathways, inducing neural ischemia and reduced grip strength.

OBJECTIVES

This study aimed to evaluate the effects of an eight-week Integrated Postural Training Program, compared with a Conventional Exercise Program, on pain, grip strength, upper limb nerve tension, and postural deviations in patients with nTOS.

METHODOLOGY: In this prospective comparative study, 110 participants (aged 20-50 years) with positive Adson tests and postural deviations were divided into Group A (Integrated Postural Training Program, n = 55) and Group B (Conventional Exercise Program, n = 55). Interventions lasted eight weeks (five days/week). Outcome measures included the Numerical Pain Rating Scale, hand dynamometer, occiput-to-wall distance (OWD) test, craniovertebral angle (CVA), and the brachial plexus compression test. Statistical significance was set at p < 0.0001.

RESULTS

Postintervention, Group A demonstrated statistically significant improvements across all parameters compared with Group B (p < 0.0001). Postintervention, Group A demonstrated a significantly greater reduction in resting pain (mean difference (MD): -1.67; 95% CI: -1.94 to -1.40) and activity pain (MD: -2.74; 95% CI: -3.06 to -2.42) compared with Group B. Group A also achieved greater structural corrections, minimizing OWD substantially (MD: -2.53 cm; 95% CI: -2.78 to -2.28) and maximizing the CVA (MD: 6.26°; 95% CI: 5.20-7.32) compared with conventional exercises.

CONCLUSION

An eight-week Integrated Postural Training Program demonstrated greater short-term improvements in pain, grip strength, postural alignment, and upper limb nerve tension compared with a conventional exercise program in patients with nTOS. While these findings suggest that targeted postural correction is a viable conservative option, larger, blinded, randomized controlled trials with long-term follow-up are needed to confirm them.