A -opracowanie koncepcji i założeń (preparing concepts) B -opracowanie metod (formulating methods) C -przeprowadzenie badań (conducting research) D -opracowanie wyników (processing results) E -interpretacja i wnioski (interpretation and conclusions) F -redakcja ostatecznej wersji (editing the final version) StreszczenieZespół Górnego Otworu Klatki Piersiowej (Thoracic Outlet Syndrom, TOS) jest jednym z najbardziej kontrowersyjnych mieszanych zespołów uciskowych (naczyniowo--nerwowych) zarówno ze względu na trudności diagnostyczne jak i brak ogólnie przyjętych standardowych algorytmów postępowania. Ocenia się, iż ta jednostka chorobowa występuje u 10 na 100 000 osób, a w obrazie klinicznym odnotowuje się przewagę objawów naczyniowych nad neurogennymi. W pracy przedstawiono patogenezę funkcjonalnej odmiany zespołu uwzględniając współczesne doniesienia związane z efektami obecnie podejmowanych kierunków postępowania leczenia zachowawczego. Przytoczono argumentację dotyczącą znaczenia poprawnej diagnostyki i wynikającej z niej możliwości zindywidualizowania terapii zgodnej z aktualnie preferowanymi kierunkami postępowania rehabilitacyjnego funkcjonującymi w dostępnej literaturze, jak również wynikającej z własnych wieloletnich doświadczeń. zespół uciskowy naczyniowo-nerwowy, TOS, klatka piersiowa, rehabilitacja, leczenie zachowawcze, powięź AbstractThoracic Outlet Syndrome (TOS) is one of the most controversial compression (vascular and neurogenic) syndromes both due to the fact it is difficult to diagnose and because of the lack of generally accepted standard procedures. It is estimated that this condition occurs in 10 out of 100 000 people, while clinical examinations reveal that arterial symptoms are more common than neurogenic ones. This work presents a pathogenesis of the functional type of the syndrome with regard to contemporary studies analysing the effects of currently applied forms of conservative treatment. The study presents arguments concerning the significance of proper diagnosis which makes it possible to individualise the therapy according to current trends in rehabilitation mentioned in the available literature and resulting from the authors' own experience.arterial-neurogenic compression syndrome, TOS, thorax, rehabilitation, conservative treatment, fascia email: piotrgodek.smc@gmail.com Słowa kluczowe:

Background. There is equivocal evidence in support of the effectiveness of each of the three co-existing approaches to conservative treatment of cervical radiculopathy (CR): biological (regenerative), mechanical (decompression) and physical (analgesic and anti-inflammatory). The aim of the study was to compare the effectiveness of the three treatment approaches in CR. Material and methods. A total of 90 patients were assigned to six treatment groups. Biological treatment: 4 ultra­sound-guided periradicular injections of ACS or PRP (1 per week); Mechanical treatment: manual therapy (MT) or traction therapy (TT) - 8 ses­sions (two per week); Physical treatment: laser therapy (LT) or collagen magnetophoresis (CM) - 8 sessions (two per week). As­sessment: before therapy (W0), after completion of the treatment (W1), two months after completion (W2). Assessment tools: NRS (0-10), NDI (0-50), cross section root area in mm2 in ultrasound examination (CRA) and hand sensorimotor function test (DPT). Results. The largest reduction in mean NRS, NDI and CRA values at W2 was observed with the biological treatments (NRS: ACS 71.7%, PRP 70.6%, NDI: ACS 61.5%, PRP 56.6%, CRA: ACS 23.6 %, PRP 25%). Improvement of hand sensorimotor functions was observed at both W1 and W2 only in the PRP group. The PRP group demonstrated a stronger analgesic effect than the ACS group at W1 (58.82% compared to 43.39%), but ACS therapy had the same effectiveness during the follow-up period. Other methods reduced pain and disability at W1, but further reduction of mean NRS values during the follow-up period was only evident in the CM group (32.25%), very mild in the MM (19.35%) and LT groups (18.75%), and the TT group actually demonstrated a regression (-5.58%). In 3 cases, TT exacerbated the symptoms, which resulted in termination of the therapy. Conclusions. 1. Biological treatments were more effective than mechanical and physical therapies in reducing pain, im­proving the disability index and proprioception of the hand both immediately on completion of therapy and after a follow-up period, which may suggest their regenerative properties. 2. Physical and mechanical therapies produced improvement in the above-mentioned indicators on completion of the therapy, but subsequently exerted a very slight effect during the follow-up period without evident regenerative effects; moreover, a regression of the results was actually recorded for traction therapy. 3. Caution should be paid when using traction therapy in the acute period of root oedema, due to possible signs of intolerance of the procedure and exacerbation of the discomfort.