Abstract | Sav proces dijagnosticiranja torakalnog outlet sindroma, odnosno sindroma gornjeg
torakalnog otvora jest kompliciran, dugotrajan i težak te je potrebno veliko znanje i vještine važne
za pravilnu i pravovremenu provedbu određenih testova i ostalih postupaka s ciljem utvrđivanja
ovog sindroma. Prvi korak jest određivanje točnih simptoma, komplikacija i ostalih tegoba
trudnice te uvid u njezino trenutačno stanje. Zatim se na temelju otkrivenih simptoma isključuje
pogrešna i postavlja pravilna dijagnoza. Do pravilne dijagnoze dolazi se pomoću testova koji
pokazuju svoju pozitivnost ili negativnost i samim time pokazuju karakteristike torakalnog outlet
sindroma na temelju vidljivih simptoma. Testovi koji se primjenjuju su Adsonov test, Allenov test,
Edenov ili Kostoklavikularni test, Roosov ili Elevated Arm Stress Test (EAST) test, Wrightov ili
Hiperabdukcijski test i Upper Limb Tension Test (ULTT). Svaki od njih ima svoje specifičnosti
koje pokazuju radi li se o sindromu gornjeg torakalnog otvora te o njegovoj razvijenosti i
mogućnostima liječenja istog. Potom je potrebno nastaviti s detaljnijim pretragama i pregledima
da se utvrdi odgovarajuća rehabilitacija i liječenje. Rehabilitacija počinje intervencijom
fizioterapeuta. U intervenciju fizioterapeuta spada pozicioniranje i edukacija trudnice te određene
vježbe. Važno je pravilno pozicioniranje i u tu skupinu rehabilitacijskih procesa spadaju posturalni
mehanizmi, kontroliranje tjelesne težine, tehnike opuštanja te načini izvođenja i nastavak
svakodnevnih aktivnosti. Trudnici prvo treba dati sve informacije o sindromu gornjeg torakalnog
otvora, o mogućnostima prilagodbe različitih aktivnosti ovisno o stanju trudnice. Važno je paziti
na određene pokrete tijela. Javlja li se mogućnost neispavanosti i nedostatak sna potrebno je dati
trudnici informacije o prilagodbi na različito pozicioniranje. Nakon toga slijede rehabilitacija
pomoću različitih vježbi. Provode se primarno vježbe disanja, a nakon toga vježbe za mobilnost i
jačanje svih mišića, osobito onih koji su oslabljeni zbog prisutnosti sindroma gornjeg torakalnog
otvora. Kod vježbi disanja bitno je spomenuti da se prakticira dijafragmalno disanje i prvi korak
jest stjecanje navike da se vrši takvo disanje. Vježbe za mobilnost i jačanje mišića uključuju razvoj
mobilne torakalne kralježnice i područja ramenog pojasa za kvalitetnije pokrete trudnice. Bitna je
opuštenost mišića, vraćanje pravilnih respiratornih obrazaca i ispravljanje lošeg držanja. Vježba
se sporo, laganim ritmom uz pratnju disanja trudnice (početna pozicija udah, izvođenje pokreta uz
izdah). Cilj je postići rehabilitaciju torakalnog outlet sindroma koja će imati dugoročne pozitivne
posljedice. |
Abstract (english) | The whole process of diagnosing thoracic outlet syndrome, ie upper thoracic orifice
syndrome, is complicated, time-consuming and difficult, and requires great knowledge and skills
important for the proper and timely implementation of certain tests and other procedures to modify
this syndrome. The first step is to determine the exact symptoms, complications and other
problems of the pregnant woman and an insight into her current condition. Then, based on the
detected symptoms, the wrong one is ruled out and the correct diagnosis is made. A correct
diagnosis can be made using tests that show their positivity or negativity and thus show an accurate
diagnosis of thoracic outlet syndrome based on visible symptoms. The tests are Adson's test,
Allen's test, Eden's or Costoklavicular test, Roos' or Elevated Arm Stress Test (EAST) test,
Wright's or Hyperabduction test and Upper Limb Tension Test (ULTT). Each of them has its own
specifics that show a diagnosis that will show that it is a syndrome of the upper thoracic opening
and its development and treatment options. It is then necessary to proceed with more detailed
examinations and examinations to determine appropriate rehabilitation and treatment.
Rehabilitation begins with the intervention of a physiotherapist. The physiotherapist's intervention
includes positioning and educating the patient and certain exercises. Proper positioning is
important and this group of rehabilitation processes includes postural mechanisms, weight control,
relaxation techniques and ways of performing and continuing daily activities. The patient should
first be given all the information about the upper thoracic orifice syndrome, about the possibilities
of adapting different activities depending on the patient's condition. It is important to pay attention
to certain body movements and there is also the possibility of insomnia and lack of sleep, so
information should be given on adjusting to different positioning that will contribute to the patient's
condition. This is followed by rehabilitation using various exercises. Primary breathing exercises
are performed, followed by exercises for mobility and strengthening of all muscles, especially
those that are weakened due to the presence of upper thoracic opening syndrome. In breathing
exercises, it is important to mention that diaphragmatic breathing is practiced and the first step is
to acquire the habit of performing such breathing. Exercises for mobility and muscle strengthening
include the development of a mobile thoracic spine and shoulder girdle area for better movements
of the pregnant woman. Muscle relaxation, restoring proper respiratory patterns and correcting
poor posture are important. Exercises are performed slowly, at a light rhythm, accompanied by the
patient's breathing (starting position inhale, performing movements with exhalation). The goal is
to achieve rehabilitation of thoracic outlet syndrome that will have long-term positive
consequences. |