Thoracic Outlet Syndrome (TOS) and the Role of Physical Therapy
Thoracic Outlet Syndrome (TOS) occurs when there is compression of neurovascular structures—nerves, veins, or arteries—within the thoracic outlet. The thoracic outlet is a narrow space between the collarbone (clavicle) and first rib, bordered by the anterior and middle scalene muscles. When this space becomes restricted, it can compress vital structures and cause a range of symptoms.
Symptoms of TOS
TOS typically presents with symptoms such as:
- Numbness, tingling, or pain radiating down the arm
- Arm and hand weakness
- Coldness or discoloration in the arm (in vascular TOS)
Approximately 90% of TOS cases result from compression of the brachial plexus nerves (C5-T1), which travel through the thoracic outlet and supply sensation and motor function to the arm.
Common Causes of TOS
TOS is often caused by factors that reduce the space within the thoracic outlet, including:
- Postural Issues: Slouched posture or forward-rounded shoulders tighten the scalene muscles and reduce space.
- Muscular Imbalance: Tight neck or chest muscles (pectoralis minor) can compress neurovascular structures.
- Bone Abnormalities: Elevated or fractured first ribs or bony abnormalities of the clavicle.
- Repetitive Movements: Overhead activities, such as swimming or weightlifting, can stress the area over time.
How Physical Therapy Helps with TOS
Physical therapy (PT) is a highly effective, non-invasive treatment for TOS. A skilled physical therapist will perform a thorough assessment during your initial evaluation to determine the cause of your TOS and design a personalized treatment plan. The goals of PT are to reduce compression, restore mobility, and improve function. Common treatments include:
- Joint Mobilizations: Techniques to improve movement in the first rib, cervical spine, and shoulder, relieving pressure on neurovascular structures.
- Soft Tissue Manual Therapy: Hands-on techniques to release tight muscles such as the scalene and pectoralis minor, which often contribute to compression.
- Nerve Gliding Exercises: Movements designed to help the brachial plexus nerves glide smoothly through the thoracic outlet, reducing pain and tingling.
- Postural Training: Exercises to strengthen the back and shoulder muscles, correcting forward head posture and rounded shoulders.
- Stretching and Strengthening: Targeted exercises to improve flexibility and strengthen weak muscles, particularly in the upper back and shoulders.
The Importance of Early Intervention
Prompt treatment of TOS through physical therapy is crucial. Early intervention can help:
- Reduce Symptoms: Alleviate pain, numbness, and tingling.
- Restore Function: Improve arm strength and mobility.
- Prevent Recurrence: Addressing posture and muscle imbalances reduces the chance of future flare-ups.
- Avoid Surgery: In many cases, conservative treatment with PT can eliminate the need for surgical intervention.
In conclusion, physical therapy is a key component in managing and overcoming Thoracic Outlet Syndrome. Through a combination of manual therapy, exercises, and posture correction, PT not only alleviates symptoms but also addresses the underlying causes of TOS to ensure long-term recovery and improved quality of life.
Written By:
Dr. Katie Hohman
Physical Therapist, Certified Lymphedema Therapist, Founder
