No abstract

Thoracic outlet syndrome involves more than just local neurovascular compression. Myofascial release treatments and stretching exercises may be only partially or temporarily successful unless all related components of somatic dysfunction, including craniosacral mechanisms, are addressed. Structural and postural abnormalities in the frontal plane, as with a short leg, and in the sagittal plane, such as lumbopelvic imbalances, as well as neural involvement all contribute to thoracic outlet syndrome symptoms. Once segmental restrictions are treated and symptoms diminish, postural correction and strengthening exercises may be initiated. Osteopathic diagnosis and treatment of the local, regional, and remote structural problems is necessary for optimal treatment of thoracic outlet syndrome and the maintenance of a symptom-free status.

This study provides proof of concept of the feasibility of studying osteopathic medical practice on a national level by developing and growing the CONCORD-PBRN.

Context: The Mini-Clinical Evaluation Exercise (Mini-CEX) is one example of a direct observation tool used for workplace-based skills assessment. The Mini-CEX has been validated as a useful formative evaluation tool in graduate medical education. However, no Mini-CEX has been reported in the literature that specifically assesses the osteopathic manipulative medicine (OMM) skills of family medicine residents. Therefore, the authors created and studied an OMM Mini-CEX to fill this skills assessment gap. Objective: To determine whether the OMM Mini-CEX is perceived as an effective evaluation tool for assessing the OMM core competencies of family medicine residents. Methods: Faculty and residents of The Wright Center for Graduate Medical Education National Family Medicine Residency program participated in the study. Each resident was evaluated at least once using the OMM Mini-CEX. Surveys were used to assess faculty and resident perceptions of the usefulness and effectiveness of the OMM Mini-CEX for assessing OMM competencies. Results: Eighty-one responses were received during 2 survey cycles within a 7-month period. The internal consistency of the survey responses had a high reliability (Cronbach α=0.93). Considering respondents who agreed that they had a clear understanding of the general purpose of a Mini-CEX, the perceived effectiveness score for the OMM Mini-CEX was higher among those who agreed that a Mini-CEX was a useful part of training than among those who disagreed or were unsure of its usefulness (median score, 4.0 vs 3.4, respectively; P=.047). Conclusions: The results suggest the OMM Mini-CEX can be a useful direct observation evaluation tool to assess OMM core competencies in family medicine residents. Additional research is needed to determine its perceived effectiveness in other clinical specialties and in undergraduate medical education.

Osteopathic manipulative treatment resulted in patient-perceived improvement in symptoms and function associated with CTS. However, median nerve function and morphology at the carpal tunnel did not change, possibly indicating a different mechanism by which OMT acted, such as central nervous system processes.