Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) encompasses a group of disorders caused by compression of the neurovascular structures, including the brachial plexus, subclavian artery, and vein, as they pass through the thoracic outlet. The thoracic outlet is anatomically defined as the passageway between the clavicle and first rib, bounded by the scalene muscles anteriorly, the first rib inferiorly, and the posterior cervical muscles posteriorly. TOS can be classified into neurogenic, vascular, or nonspecific types, each presenting with distinct clinical features.

TOS can arise from various anatomical anomalies or acquired conditions that result in compression of the thoracic outlet structures. Common etiological factors include congenital anomalies such as cervical ribs, abnormal scalene muscle anatomy, muscular hypertrophy, trauma, poor posture, repetitive overhead activities, and anatomical variations in the bony and soft tissue structures. The compression leads to ischemia, nerve irritation, and mechanical distortion, giving rise to the characteristic symptoms of TOS.

Patients with TOS typically present with a constellation of symptoms, including pain, numbness, tingling, and weakness in the upper extremities. Neurogenic TOS primarily manifests with neurological symptoms, such as paresthesia along the ulnar aspect of the forearm and hand, while vascular TOS presents with symptoms related to arterial or venous compromise, such as cold intolerance, pallor, and swelling. Nonspecific TOS may exhibit a combination of neurogenic and vascular symptoms, making diagnosis challenging and often necessitating a multidisciplinary approach.

Manual therapy encompasses a variety of hands-on techniques aimed at restoring mobility, reducing pain, and improving function in musculoskeletal disorders. In the context of TOS, manual therapy interventions target the underlying musculoskeletal and soft tissue dysfunctions contributing to thoracic outlet compression. Techniques commonly employed include:

• Soft Tissue Mobilisation: Manual manipulation of soft tissues, such as massage, myofascial release, and trigger point therapy, aims to alleviate muscular tension, reduce adhesions, and improve blood flow to the affected area.
• Joint Mobilisation: Gentle mobilisation of the thoracic spine, cervical spine, and ribs can help restore normal joint mechanics, alleviate restrictions, and reduce nerve impingement.
• Stretching and Strengthening Exercises: Specific exercises targeting the muscles of the neck, shoulder girdle, and upper extremities can improve flexibility, strength, and postural alignment, thereby reducing compression on the thoracic outlet structures.

• Postural Correction: Education and training in proper posture and ergonomics are essential components of manual therapy for TOS, as poor posture contributes to thoracic outlet compression and exacerbates symptoms.

Listed below are some details of a client dealing with pain associated with TOS who is seeking treatment here at HBM, which may also serve as a case study:

Age: 40+

Gender: M

Symptoms: Nerve pain in elbow down to index finger on R hand

Medical history: No known injuries of relevance.

Lifestyle: Travels abroad frequently for work, while finishing a PhD at the same time.

The client has received 5x treatments here at HBM over 5 months to manage his symptoms, and even after the first treatment has had great improvement in mobility and pain. Educating him on the importance of compliance to treatment even with such a busy schedule has made a big difference on his quality of life, and after educating him on the possible cause (after numerous questioning and orthopaedic testing) and with some take home exercises and stretches, he’s been able to get back to his daily activities with much improvements on symptoms.

If you or someone you know are dealing with TOS, musculoskeletal pain, or even myofascial trigger points, book in an appointment to see us now for an initial consultation so we can assess your condition and come up with an appropriate and tailored treatment plan to manage your pain.

Simply click this booking link for the myotherapy initial consultation with our experienced myotherapists.