Blog, Physiotherapy

Understanding Thoracic Outlet Syndrome and the Role of Physiotherapy

Thoracic Outlet Syndrome (TOS) is a complex condition that occurs when the blood vessels or nerves in the space between the collarbone (clavicle) and the first rib, known as the thoracic outlet, become compressed.

This compression can lead to various symptoms, including pain, numbness, and weakness in the upper limbs, neck, and shoulders.

TOS can be categorised into three primary types: neurogenic, vascular, and nonspecific.

Each type has different causes and treatment approaches, and physiotherapy can play a crucial role in managing and alleviating symptoms.

Types of Thoracic Outlet Syndrome

Neurogenic Thoracic Outlet Syndrome (nTOS): This is the most common type of TOS and occurs when the brachial plexus, a network of nerves that controls muscle movements and sensations in the shoulder, arm, and hand, becomes compressed. Symptoms may include numbness, tingling, and weakness in the arm or hand.
Vascular Thoracic Outlet Syndrome (vTOS): This type occurs when the blood vessels, particularly the subclavian artery or vein, are compressed. Patients may experience swelling, discoloration, and coldness in the affected arm. In severe cases, it can lead to blood clots.
Nonspecific Thoracic Outlet Syndrome: Sometimes referred to as disputed TOS, this type presents with symptoms but lacks clear evidence of nerve or blood vessel compression. It is often associated with postural issues and repetitive strain.

Causes and Risk Factors

TOS can be caused by various factors, such as:

Anatomical abnormalities: Extra ribs (cervical ribs), tight muscles (especially the scalene muscles), or abnormal fibrous bands can compress the thoracic outlet.
Poor posture: Slouching or hunching over, particularly in desk jobs, can increase the risk of developing TOS by compressing the thoracic outlet.
Trauma or injury: Car accidents, sports injuries, or repetitive strain (e.g., from carrying heavy loads or certain overhead movements) can contribute to the development of TOS.
Pregnancy: Hormonal changes during pregnancy can cause loosening of joints, potentially contributing to thoracic outlet compression.

Symptoms

TOS symptoms vary depending on the type but may include:

Pain and tingling in the neck, shoulder, arm, or hand.
Numbness and weakness in the affected limb.
Coldness or discolouration in the arm or hand (more common in vascular TOS).
Swelling in the arm or hand.

These symptoms may worsen with certain activities, such as lifting the arm above the head, carrying heavy objects, or sitting with poor posture for extended periods.

How Physiotherapy Can Help

Physiotherapy is a key component of conservative treatment for Thoracic Outlet Syndrome, especially for neurogenic and nonspecific types.

The primary goals of physiotherapy in treating TOS include reducing symptoms, improving posture, increasing mobility, and strengthening muscles to relieve pressure on the thoracic outlet.

Posture Correction: Many TOS cases result from poor posture, such as forward head position or rounded shoulders. Physiotherapists work on correcting posture through specific exercises and ergonomic advice, which can alleviate compression on the nerves and blood vessels.
Stretching and Flexibility Exercises: Tight muscles around the thoracic outlet, such as the scalene, pectoralis minor, and subclavius muscles, can contribute to compression. A physiotherapist will guide patients through stretching exercises designed to relieve tension and improve flexibility.
Strengthening Exercises: Weak muscles in the upper back and shoulders can exacerbate TOS. Physiotherapists prescribe strengthening exercises targeting the shoulder girdle and upper back to improve support and stability, reducing strain on the thoracic outlet.
Manual Therapy: Hands-on techniques, such as soft tissue massage and joint mobilizations, can help release tight muscles, improve circulation, and reduce nerve compression. These therapies may relieve pain and enhance mobility.
Education and Activity Modification: Physiotherapists educate patients on modifying activities that may aggravate symptoms. This may include adjusting workspace ergonomics, avoiding repetitive overhead motions, and learning proper lifting techniques.

Conclusion

Thoracic Outlet Syndrome can be a debilitating condition if not managed properly, but with early diagnosis and an individualised treatment plan, it can be effectively managed.

Physiotherapy offers a non-invasive, conservative approach that focuses on relieving symptoms, correcting posture, and strengthening the muscles around the thoracic outlet.

By addressing the root causes of compression, physiotherapy helps patients regain mobility and function, allowing them to return to daily activities with less discomfort.

If you or someone you know is struggling with TOS, consult the expert physiotherapists at M Physio Zetland to embark on a path toward pain relief and improved quality of life.