Thoracic Outlet Syndrome – Tips for Effective Management and Relief
Thoracic Outlet Syndrome (TOS) is a condition that can cause pain and discomfort as well as limitations of activities of daily living.
It occurs when the blood vessels or nerves in the narrow passageway between your collarbone and first rib (the thoracic outlet) become compressed.
The syndrome can be challenging and the symptoms can be particularly difficult to manage and overcome but in this blog post I’m going to give you all the information that you need on the condition itself but also importantly explore how Physiotherapy can help you find relief from the symptoms and ultimately improve your quality of life again.
anatomy of the thoracic outlet
The area between the collarbone and the first rib contains several structures. These include the brachial plexus (the nerves controlling the arm and hand), subclavian artery and subclavian vein. When any of these structures are compressed or irritated it can lead to TOS.
types of TOS and their symptoms
TOS can be divided into three main types:
Neurogenic TOS
This occurs when the brachial plexus nerves become compressed. This is the most common form of TOS.
Symptoms can include:
1. Pins and needles or numbness in the hand and fingers
2. Change in skin colour
3. Dull pain in the neck, armpit and shoulder
4. Cold hands
Venous TOS
This is where the subclavian vein is compressed.
Symptoms can include:
1. Arm that feels cooler
2. Skin that is paler in the affected arm
3. Weak or absent pulse
4. Arm or neck weakness
Arterial TOS
This is where the subclavian artery is compressed.
Symptoms can include:
1. Change in colour in the hands and fingers
2. Cold sensitivity in the hands and fingers
3. Poor circulation in the affected arm
4. Arm heaviness
5. Pins and needles or numbness
Causes of TOS
- Poor posture
- Trauma or injury
- Anatomical anomalies
- Muscle imbalances
- Tumours that compress the nerves
- Repetitive overhead movements
- Pregnancy
How is TOs Diagnosed?
When you see a Physiotherapist for the first time they will conduct a full physical assessment which will include taking a full history, examination of your posture, muscle strength and range of motion. and the performance of some basic provocation tests.
This is often enough to begin treating the condition. If TOS is suspected further tests can then be performed. The Physiotherapist will refer you back to your doctor who might organise for you to have imaging studies such as x-rays, MRI or ultrasound scans which can help visualise structural abnormalities or compressions.
Nerve conduction tests can help to evaluate nerve function.
PHYSIOTHERAPY MANAGEMENT OF TOS
These may include:
1. Posture Correction
2. Stretching Exercise
3. Strengthening Exercises
Specific exercises will help to strengthen the muscles around the TOS. This will provide better support and reduce compression in the area.
4. Manual Therapy
Techniques such as soft tissue massage, joint mobilisations and myofascial release can help to relieve muscle tension and improve blood flow.
5. Nerve Gliding Exercises
For Neurogenic TOS nerve gliding exercises can help release the pressure on the nerve and alleviate symptoms.
6. Breathing Exercises
7. Modalities
Some physiotherapists like to use electrotherapy to help alleviate the symptoms, although the research for this is not very conclusive. But other modalities such as TENS machines for pain or heat for muscle relaxation can be used effectively.
8. Education
Your Physiotherapist will give you some information on lifestyle modifications such as ergonomics to help with your symptoms and prevent them from returning in the future.
Patient Success stories
Case Study 1 - Jane's Journey to Recovery
Jane is a 40-year-old office worker who presented with Neurogenic TOS due to poor posture over a prolonged period of sitting at her desk.
Her symptoms were significant and included neck and shoulder pain, and pins and needles in her hand and finger. She also complained of having a cold hand on the affected side.
Jane's physiotherapy treatment included postural correction stretches and strengthening exercises, nerve gliding techniques and some manual therapy aimed at relaxing the muscles around the neck and collarbone. After 8 weeks of completing her rehabilitation exercises and attending 4 sessions of Physio, Jane's symptoms were much improved and a full resolution was obtained at 16 weeks.
Case Study 2 - John's battle with Arterial TOS
John is a 45-year-old mechanic who developed vascular TOS following a car accident. He developed weakness in his right arm together with pain in his collar bone.
His physiotherapy treatment focused on helping him reduce inflammation, improve circulation, and release of the muscles around the thoracic outlet.
John regained full strength in his right arm and achieved full resolution of his pain.
conclusion
TOS can be a challenging condition to manage. In some incidences, surgery is required to free the compression.
However, with the right conservative treatment matching the correctly diagnosed version of TOS, treatment can be successful.
If you suspect that you have TOS or perhaps you have already been diagnosed, consult with your physiotherapist to create a personalised treatment plan. With this guidance, you will stand the best chance of overcoming the limitations of TOS and living a pain-free, active life.
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