What is Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) is a potentially painful and disabling condition of the upper extremity. It results from the compression of structures in the thoracic outlet, a space just above the first rib, and behind the clavicle (collar bone). Due to the range of signs and symptoms that can lead to a diagnosis of TOS, the incidence rates of the condition currently are unknown. Physical therapists work with individuals who have TOS to ease their symptoms and restore their upper-body function.

How Does It Feel?

Because TOS generally is classified based upon the type of structures compressed, the symptoms experienced may vary. However, more than 90% of TOS cases are thought to be neurogenic (nerve compression) in nature (categories 3 and 4 below).

Arterial TOS

·       – Pain in the hand; rarely in shoulder or neck

·       – Coldness or cold intolerance

·       – Numbness and tingling

Venous TOS

·       – Pain in the arm

·       – Swelling in the arm

·       – Change in arm coloration (appears bluish)

·       – Feeling of heaviness in the arm

·       – Numbness and tingling in fingers and hands

True Neurogenic TOS

·       – Pain, numbness, and tingling in the hand, arm, shoulder, and often the neck

·       – Headaches

·       – Numbness and tingling of the arm, often waking the individual up at night

·       – Hand clumsiness

·       – Intolerance to cold

·       – Hand coldness and color changes

Disputed Neurogenic TOS

·       – Pain, numbness and tingling in the hand, arm, shoulder and often the neck

·       – Headaches

·       – Numbness and tingling of the arm, often waking the individual up at night

·       – Hand clumsiness

·       – Intolerance to cold

·       – Hand coldness and color changes

·       – Symptoms greater at night vs day

·       – Tests may come back normal (hence, the term “disputed”)

How Can a Physical Therapist Help?

Once you have received a diagnosis of TOS, your physical therapist will work with you to develop a treatment plan to help ease the discomfort, and improve your ability to perform daily activities. Most research on this condition recommends a treatment plan that involves physical therapy to help ease your symptoms and improve function.

Physical therapy treatments may include:

– Manual Therapy

– Movement and Strengthening Exercises

– Education

– Activity modification and postural strategies

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions, and also prepare them for their visit with their health care provider.