What is thoracic outlet syndrome?

What is thoracic outlet syndrome?

‍

Thoracic outlet syndrome (TOS) is a group of disorders characterized by the compression or irritation of the nerves and blood vessels that pass through the thoracic outlet. It encompasses a variety of clinical problems in the shoulder region. The thoracic outlet is a small passageway between the base of the neck and the armpit, through which nerves, blood vessels, and muscles travel from the neck to the upper extremities (arms).

‍

The thoracic outlet is bordered by several structures, including the first rib, clavicle (collarbone), and various muscles in the neck and shoulder region. When there is compression or impingement of the nerves (brachial plexus) or blood vessels (subclavian artery or vein) passing through this narrow space, it can lead to various symptoms, collectively referred to as thoracic outlet syndrome.

‍

There are three main types of thoracic outlet syndrome:

1. 1Neurogenic Thoracic Outlet Syndrome (NTOS): This is the most common type and also known as the ‘true TOS”, accounting for about 95% of cases. NTOS occurs when the brachial plexus, a network of nerves that controls arm and hand movements, becomes compressed or irritated. This can result in symptoms such as pain, weakness, and numbness in the arm and hand.
2. Vascular Thoracic Outlet Syndrome (VTOS): VTOS is less common and involves the compression or obstruction of the subclavian artery or vein with arm motion, especially with overhead usage, which can lead to symptoms such as arm swelling, pain, and discoloration upon prolonged use.
3. Nonspecific or Disputed Thoracic Outlet Syndrome: This category is used for cases where symptoms are present, but there is no clear evidence of nerve or vascular compression. It is often more challenging to diagnose and treat. Often, there is a postural component. Most TOS complaints fall into this category.

Common symptoms of thoracic outlet syndrome

‍

The anatomy of the thoracic outlet region is extremely complex. When the neurologic structures are entrapped, arterial and venous structures may also be affected. Common symptoms of thoracic outlet syndrome include:

• Pain in the neck, shoulder, and arm particularly at the end of the day.
• Numbness or tingling in the arm or fingers.
• Weakness that occurs in the muscles corresponding to nerve root innervation. It commonly affects the arm or hand.
• Vascular symptoms such as; coldness and swelling, fatigue in the hand or arm and cyanosis (bluish discoloration). 

‍

Diagnosing thoracic outlet syndrome requires a thorough medical history, physical examination, and may involve imaging tests such as X-rays, MRI, or ultrasound to identify the underlying cause of compression.

‍

Treatment for thoracic outlet syndrome may include physical therapy, with the primary emphasis of management is to decrease the mechanical pressure by increasing the mobility of tissues in the thoracic outlet region, preventing recurrence of the compression loads by correcting the postural alignment and developing endurance to maintain a correct posture. In severe cases, surgical intervention may be required to relieve compression on the affected nerves or blood vessels. The specific treatment plan depends on the type and severity of TOS and should be determined by a qualified healthcare professional.

‍

What causes thoracic outlet syndrome?

‍

There are three known causative factors for TOS that could be interrelated or exist separately and may include: 

‍

1. Compressive Neuropathy: Compression of the neurovascular structures can occur if there is decrease in the size of the area in which the nerves and blood vessels pass through. This compression can result from muscle hypertrophy (increase in muscle size), anatomical anomalies, such as fractured clavicle (collar bone), adaptive shortening of muscles and a space occupying lesion.
2. Faulty Posture: Changes in posture, particularly forward head and rounded shoulders narrow the spaces through which the nerves and blood vessels pass. Other contributing factors to postural stresses include; pressure from undergarment support straps and carrying a heavy briefcase, suitcase or shoulder purse that causes pressure on the shoulder area.
3. Traumatic Injuries: Injuries such as fracture and dislocation on the neck and shoulder region could result in inflammation and compression of the structures that pass through it, leading to TOS symptoms.

‍

How can physical therapy help? 

‍

Physical therapy plays a crucial role in the management and treatment of thoracic outlet syndrome (TOS). A physical therapist can help address the underlying causes of TOS and provide targeted interventions to relieve symptoms, improve posture, and enhance the overall function of the affected arm and shoulder. Here's how physical therapy can help with thoracic outlet syndrome:

‍

1. Posture Correction: Poor posture is a common contributing factor to TOS. A physical therapist will assess your posture and provide exercises and guidance to improve spinal alignment and reduce pressure on the thoracic outlet.
2. Stretching Exercises: Specific stretching exercises are prescribed to improve the flexibility of the muscles around the neck, shoulder, and chest. Manual and self-stretching techniques are utilized to address mobility impairments. These stretches can help alleviate tension and reduce compression on the nerves and blood vessels passing through the thoracic outlet.
3. Strengthening Exercises: Physical therapists design a customized strengthening program to target weak muscles, as well as to improve control and endurance in the postural muscles. Strengthening these muscles can help stabilize the thoracic outlet and improve its function.
4. Nerve Mobilization : Specialized exercises such as nerve mobilization maneuvers are employed to gently mobilize and glide the nerves through their natural pathways, helping to reduce nerve compression and improve nerve function.
5. Modalities: Therapeutic modalities such as heat or cold therapy, ultrasound, and electrical stimulation may be used to reduce pain, inflammation, and muscle tightness in the affected area.
6. Breathing Exercises: If the patient tends to use an apical breathing pattern (excessive movement of the chest and shoulder upon breathing) which causes increased tension in the neck muscles, the physical therapists will teach breathing patterns and exercises that will relax the upper trunk. 
7. Patient Education: Physical therapists will teach the patients with TOS how to modify or eliminate provoking posture and activities. They also provide education about the importance of compliance to reduce the stresses on the nerve and vascular structures.
8. Home Exercise Program: To facilitate ongoing progress, physical therapists provide patients with a tailored home exercise program that includes flexibility and postural exercises to reinforce the intervention.

‍

It's essential to remember that the treatment plan will vary depending on the specific type and severity of thoracic outlet syndrome. Physical therapy for TOS is generally a conservative approach and can be highly effective when done consistently and under the guidance of a skilled physical therapist. If you suspect you have thoracic outlet syndrome or experience symptoms like pain, numbness, or weakness in your arm or hand, consult a healthcare professional for a proper evaluation and appropriate treatment plan.

Trust PeteHealth for thoracic outlet syndrome treatment

Looking for a physical therapist to help you manage and treat thoracic outlet syndrome? PeteHealth is the trusted physical therapy solution that you can access on your schedule, bringing you the care you need wherever you need it – including your home or office. Our licensed physical therapists are at the top of their profession, and we accept most insurance carriers.

‍

Finally – the all-in-one, professional, convenient approach to physical therapy that you deserve with PeteHealth.

‍