Thoracic Outlet Syndrome (TOS)
What is Thoracic Outlet Syndrome?
Thoracic Outlet Syndrome (TOS) is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can lead to pain in your shoulders and neck and numbness in your fingers.
Types of TOS
- Neurogenic TOS: Most common type, affecting the brachial plexus (nerves).
- Venous TOS: Affects the veins, causing blood clots and swelling.
- Arterial TOS: Least common; involves compression of the arteries.
Causes of Thoracic Outlet Syndrome
- Poor posture
- Trauma (e.g., car accident or repetitive injuries)
- Anatomical defects (e.g., cervical rib)
- Pregnancy
- Repetitive arm and shoulder movements
Symptoms
- Neck, shoulder, or arm pain
- Numbness or tingling in the fingers
- Weak grip
- Swelling or discoloration in the arm
- Coldness in the hands and fingers
Diagnosis
Diagnosis of TOS involves a physical examination, patient history, imaging tests such as X-rays or MRI, and nerve conduction studies to evaluate the functionality of the nerves.
Physiotherapy Management
Physiotherapy is a key treatment option for TOS, especially neurogenic TOS. It includes:
- Postural training to correct rounded shoulders and forward head position.
- Stretching exercises for scalene muscles, pectoralis minor, and upper trapezius.
- Strengthening exercises for scapular stabilizers.
- Neural mobilization for brachial plexus nerves.
- Breathing techniques to reduce tension in accessory breathing muscles.
Medical and Surgical Options
When physiotherapy does not resolve symptoms, other options may include medications like anti-inflammatory drugs, pain relievers, and in some cases, surgery to remove the first rib or release the compressed nerve or blood vessel.
Precautions
- Avoid prolonged overhead activities
- Take breaks during repetitive work
- Use ergonomic chairs and workstations
- Maintain proper posture
FAQs About Thoracic Outlet Syndrome
TOS can be caused by anatomical defects, trauma, poor posture, or repetitive overhead activity.
Diagnosis involves clinical assessment, imaging tests, and nerve studies.
Common symptoms include pain in the neck and shoulders, numbness in the fingers, and weakness in the arm.
Physiotherapy can effectively manage and even reverse symptoms of neurogenic TOS with consistent effort.
Stretching, postural training, and neural glides are commonly used exercises.
Surgery is only considered when conservative treatments fail, especially for venous or arterial TOS.
In mild cases, symptoms may improve with posture correction and lifestyle changes.
Recovery varies but can take several weeks to months depending on severity and treatment.
It can be managed and often resolved with proper care, though chronic cases may persist.
Yes, prolonged poor posture is a common cause of neurogenic TOS.
Neural glides are exercises that gently mobilize nerves through their range to reduce compression.
Yes, especially in sports involving repetitive overhead arm use like swimming or baseball.
Some chiropractors may help with symptoms, but physiotherapy is typically more structured and evidence-based.
It usually affects one side, but in rare cases, both arms may be involved.
Yes, sleeping with arms overhead or on a firm pillow may worsen symptoms.