What is Thoracic Outlet Syndrome?

Pins, needles or numbness in your pinky and ring finger? Tight neck and chest muscles? You may be suffering from Thoracic Outlet Syndrome or TOS. In this article we explain what TOS is, common causes of TOS, symptoms of TOS, what you can do right now for TOS, what your physio/osteo will do for TOS, how TOS is diagnosed and how long until TOS gets better!

If you’re finding this article too long, check out this short video with Dr. Abbey Davidson (Osteopath) on Thoracic Outlet Syndrome:

What is Thoracic Outlet Syndrome or TOS?

Blausen Medical

Thoracic Outlet Syndrome or TOS is a group of disorders that stem from pressure being placed on the neurovascular bundle (arteries, nerves and veins) that supply the arm. The thoracic outlet is the passageway from the neck base to the armpit. It is formed by the collar bone, first rib, trapezius, sternocleidomastoid (SCM), subclavius, pectoralis and scalene muscles. Passing through the thoracic outlet is the subclavian vein, subclavian artery and brachial nerve plexus.

Narrowing of the thoracic outlet like with poor desk posture, overhead activity or trauma; results in less room for the neurovascular bundle. This can result in pressure or compression of these arteries, veins and/or nerves and symptoms in the same arm and hand.

TOS is more common in women than men and is usually occurs between 20-50 years of age. Several professional baseball and basketball players have suffered with this condition but it also common in desk workers and other repetitive strain occupations.


Causes of Thoracic Outlet Syndrome:

TOS occurs in approximately 1% of the population; common causes of TOS include:

  • Trauma (car accident/whiplash)
  • Repetitive micro-trauma (job or hobby related)
  • Anatomic difference (e.g. cervical rib)
  • Pregnancy
  • Tumor

If you have a suspicion you may have TOS it is important to have a trained professional assess and diagnose the cause of your symptoms. After you have been diagnosed, appropriate management/treatment can commence to resolve TOS.


Signs and Symptoms of Thoracic Outlet Syndrome:

Passing through the thoracic outlet is the subclavian vein, subclavian artery and brachial nerve plexus.TOS mainly effects the upper limbs. Some common signs and symptoms of TOS include:

  • Shoulder, neck, arm and hand pain
  • Shoulder, arm and hand weakness
  • Pins, needles and numbness (especially in the pinky/ring finger)
  • Coldness, paleness and discoloration of the fingers
  • Tightness in neck and chest muscles

Symptoms affecting the arm that stem from the neck can also indicate a range of other diagnoses. If you are concerned you are suffering from Thoracic Outlet Syndrome it is important to be assessed by your physiotherapist, osteopath or other health professional.


What you can do right now for Thoracic Outlet Syndrome?

If it has been confirmed that you are indeed experiencing TOS here is some simple advice to help with your recovery.  Rest, stretching and postural exercises are a good place to start.

If you have TOS consider rest. This doesn’t mean limit yourself to bed rest but instead avoiding activities which narrow the thoracic outlet. This includes overhead repetitive motions or activities where you are really straining your neck (e.g. lifting heavy weights at gym). This may mean discussing with your boss alternate duties or with you coach for alternate drills.

Stretches like those demonstrated at the video at the top of page can be very useful for TOS symptoms. Those that target the scalene and pectoralis minor muscle are particularly beneficial as TOS nerves and blood vessels are closely related to these muscles.

Specific Exercises which target posture and opening the thoracic outlet like those demonstrated in the video at the top of page are recommended. Scapular squeeze or retraction exercises and shoulder traction exercises are a good place to start. Nerve glide exercises can also be beneficial (especially for Ulna Nerve) if pins, needles and numbness are your main complaint.

With TOS it is important to improve your posture. The more forward your head carriage and internally rotated your shoulders are (e.g. common with desk workers) the smaller your thoracic outlet. Take regular micro-breaks and practice an ergonomic desk set up for a start. This may also mean spending less time on the couch


Physio and Osteo treatment for Thoracic Outlet Syndrome:

TOS occurs in approximately 1% of the population After establishing if you are suffering from TOS your physio or osteo will spend time educating you on what your condition is, what their treatment plan entails and explaining your major contribution in resolving your symptoms.

Hands on therapy will focus on reducing muscular tension around the region (especially scalene and pectoralis), improving joint range of motion (neck, mid-back, shoulder, etc) and improving posture to maximise space in the thoracic outlet.

Sessions will be complemented by the prescription of strengthening exercises to correct posture, improving nerve gliding motion and specific stretches.  Your health professional will also provide advice on how to avoid TOS reoccurring. This may involve encouraging micro-breaks, improving desk posture/ergonomics and avoiding repetitive strain in your day to day life. This advice will be personalised specifically for you.


How is Thoracic Outlet Syndrome Diagnosed?

Your physiotherapist or osteopath will take a medical history and ask you specific questions related to your symptoms. They will assess the area and perform orthopedic tests to try and provoke your symptoms. If they are satisfied that you are in fact suffering from TOS they will commence conservative management or treatment.

In some cases, you may be sent for further testing including X-ray, MRI, CT arteriography and nerve conduction studies to confirm your health professional’s suspicions.


How long until Thoracic Outlet Syndrome gets better?

TOS can resolve completely with appropriate physiotherapy and/or osteopathy treatment. Sessions are supported by stretches, exercise, advice and education that is provided by your health professional. Full recovery time is variable and depends heavily upon compliance to advice and exercises. Good results should be seen within 4-6 weeks

Surgery may be considered if you have anatomical differences (such as a cervical rib) that will continue to cause issues in the future. Usually conservative management is trialed first and surgery is considered when arterial and neurological symptoms don’t resolve with physiotherapy or osteopathic treatments.


By Sydney CBD Osteopath Dr Abbey Davidson

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