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Thoracic Outlet Syndrome



Thoracic outlet syndrome (TOS) is the term used to describe symptoms produced from the compression of nerves or blood vessels running through the thoracic outlet.

The thoracic outlet is the area between the base of the neck and the armpit. The main area affected is known as the brachial plexus, which comprises of the nerves that pass into the arms from the neck.

Incidence and Prevalence


Certain unique facts have been observed regarding the occurrence of the thoracic outlet syndrome. Here we list some of them:

i) The disease has higher occurrence in women than in men.

ii) People born with a ‘cervical rib’ (extra rib in the neck) are 10 times more likely to develop TOS.

iii) People working on assembly lines, keyboards, 10-key pad and on filing and stocking shelves overhead are more vulnerable.

Key Symptoms


The key symptoms of thoracic outlet syndrome include:

• Swelling or puffiness in the arm or hand

• Bluish discoloration of the hand

• Feeling of heaviness in the arm or hand

• Pulsating lump above the clavicle (collarbone)

• Deep, boring pain (like tooth-ache) in the neck and shoulder region, especially intense at night

• Pain in the arm and hand

• Tingling and numbness in the neck, shoulder region, arm and hand

• Difficulty with fine motor tasks of the hand

• Cramps of the muscles on the inner forearm

• Parasthesia along the inside forearm and the palm

Causative factors


The thoracic outlet syndrome is primarily considered a result of injury, disease or a congenital abnormality. Poor posture and obesity can often aggravate the condition.

Other causes include:


• Whiplash injuries

• Repetitive stress in the workplace

• Neck injuries

Treatment Modalities


The treatment plan for the thoracic outlet syndrome is devised by combining various physical therapy techniques, followed by prescription of analgesics in some cases and surgery in rare cases. Here we list the main techniques, along with their objectives:

1. General physical therapy, to gain full range of motion and building muscle strength.

2. Postural therapy to reduce stress and pressure on the nerves.

3. Muscle strengthening, for better body support and stabilization.

4. Nerve gliding, to keep nerves moving and free of scarring.

5. Stretching and massage, allowing the muscles to stay looser, thus preventing pain or injury.

6. Chiropractic and acupuncture, as alternate therapies

7. Feldenkrais, teaching the patient to improve posture

8. Electronic muscle stimulation

9. Ice/heat for decreasing inflammation and relieving sore muscles respectively.

10. TENS (Transcutaneous Electrical Nerve Stimulations) Unit, relieving pain by sending small electrical impulses through electrodes placed on the skin.

11. Hyperbaric Oxygen Therapy, in which the patient breathes 100% oxygen in the hyperbaric chamber, helping to repair damaged nerves.

12. Edgeglow technique, aimed at helping the patient to listen to his body and control the onset of any pain or tension.


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