Costoclavicular Test was positive for compression of the neurovascular bundle between the clavicle and 1^st rib. The “big hit” compressed the clavicle to the 1^st rib and created this form of Thoracic Outlet Syndrome. Using a backpack, bringing the shoulders back and performing dead lifts all exacerbated the compression.

Manipulative therapeutics were initiated into the sternoclavicular joint and acromioclavicular joint as well as 1^st rib and anterior flexion fixations of the cervical spine. Modalities and manual methods were used to treat spasms in the scalenes, SCMs, upper trapezius and pectoralis muscles as secondary factors in this patient’s presentation. The patient was told to refrain from using his right shoulder to take hits during practice until his symptoms abated. He was also instructed to carry his backpack in front of him and refrain from dead lifts. This patient’s condition healed during summer practice and he was able to participate in games during the season.

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