News & Conditions

THORACIC OUTLET SYNDROME

Thoracic outlet syndrome (TOS) is a condition where there is compression or irritation of the nerves, blood vessels, or both in the thoracic outlet. The thoracic outlet is the space between the collarbone and the first rib. This can result in pain, numbness, tingling, and weakness in the shoulder, arm, and hand.

There are three types of TOS: neurogenic, vascular, and nonspecific.

Neurogenic TOS is the most common type and occurs when there is compression or irritation of the brachial plexus, a network of nerves that runs from the neck to the armpit and down the arm. This can result in pain, numbness, tingling, and weakness in the shoulder, arm, and hand.

Vascular TOS occurs when there is compression or irritation of the blood vessels that supply the arm, resulting in pain, swelling, and discoloration in the arm.

Nonspecific TOS is a diagnosis of exclusion when symptoms do not fit into either of the above categories.

The causes of TOS can include physical trauma, repetitive strain injury, poor posture, and anatomical variations such as a cervical rib or abnormal muscles.

The diagnosis of TOS involves a thorough history and physical examination, imaging tests such as X-rays or MRI, and nerve conduction studies.

Treatment for TOS can involve physical therapy to improve posture and strengthen the shoulder and neck muscles, as well as techniques to reduce nerve compression such as stretching and manual therapy. In some cases, surgery may be necessary to relieve pressure on the nerves or blood vessels.

SYMPTOMS

The symptoms of thoracic outlet syndrome (TOS) can vary depending on the type and severity of the condition.

The most common symptoms of neurogenic TOS include:

• Pain in the neck, shoulder, and arm
• Numbness, tingling, or weakness in the arm or fingers
• Muscle wasting or weakness in the hand
• Swelling or discoloration of the arm
• Coldness or fatigue in the arm or hand

The symptoms of vascular TOS include:

• Swelling, discoloration, or blueness of the arm
• Pain or discomfort in the arm, especially when using it
• Weakness or fatigue in the arm

Nonspecific TOS can present with a variety of symptoms that may not fit into either category, such as:

• Pain or discomfort in the neck, shoulder, or arm
• Numbness, tingling, or weakness in the arm or fingers
• Swelling or discoloration of the arm
• Headaches or migraines
• Fatigue or weakness

If you are experiencing any of these symptoms, it is important to see a healthcare professional for an evaluation and diagnosis.

CAUSES OF THORACIC OUTLET SYNDROME

Thoracic outlet syndrome (TOS) can be caused by a variety of factors, including:

1. Poor posture: When you sit or stand with your shoulders hunched forward(Kyphosis), it can put pressure on the nerves and blood vessels in your neck and shoulder area.
2. Trauma: A car accident, fall, or other trauma can damage the nerves or blood vessels in the thoracic outlet.
3. Repetitive activities: Certain repetitive activities such as typing on a computer, carrying heavy bags or backpacks, or playing certain sports can lead to TOS.
4. Anatomical abnormalities: Some people may be born with an extra rib or other abnormality that causes compression of the nerves and blood vessels in the thoracic outlet.
5. Tight muscles: Tight muscles in the neck, shoulders, or chest can put pressure on the nerves and blood vessels in the thoracic outlet.
6. Tumors: In rare cases, a tumor in the neck or chest can put pressure on the nerves and blood vessels in the thoracic outlet, leading to TOS.

It is important to see a healthcare professional for an evaluation and diagnosis if you are experiencing symptoms of TOS.

ROLE OF PHYSIOTHERAPIST

A physiotherapist can play an important role in the management of thoracic outlet syndrome (TOS). They can help to:

1. Diagnose the condition: A physiotherapist can perform a thorough assessment to determine if the symptoms are related to TOS or another condition.
2. Develop a treatment plan: Based on the assessment findings, a physiotherapist can develop an individualized treatment plan that may include exercises to improve posture, stretching and mobilization of the affected muscles and joints, and other modalities such as massage, electrotherapy, or dry needling.
3. Provide pain relief: A physiotherapist can use various techniques to help reduce pain and inflammation, such as ice, heat, or ultrasound.
4. Improve range of motion and strength: By performing specific exercises, a physiotherapist can help to improve range of motion and strength in the affected area, which can help to reduce symptoms and prevent further injury.
5. Educate on lifestyle modifications: A physiotherapist can provide advice on modifications to work, home, and recreational activities to reduce strain on the affected area and promote healing.
6. Monitor progress: A physiotherapist can monitor progress over time and adjust the treatment plan as necessary to ensure the best possible outcome.

ROLE OF CHIROPRACTOR

Chiropractors may also play a role in the management of thoracic outlet syndrome. They may use manual therapies such as spinal manipulation and mobilization to alleviate joint restrictions and improve mobility in the neck and upper back. They may also use soft tissue techniques to release muscle tension and improve circulation to the affected area. Additionally, chiropractors may prescribe exercises to strengthen the muscles around the shoulder girdle and improve posture, which can help prevent further episodes of thoracic outlet syndrome