Thoracic Outlet Syndrome (TOS) is a complex condition that affects the nerves and blood vessels passing through the thoracic outlet. Compression of the thoracic outlet can lead to pain, numbness, and weakness in the arms and shoulders. These symptoms impact everyday activities and your quality of life. Trauma, repetitive motions, or anatomical abnormalities can cause TOS.

However, with the proper treatment approach, many individuals find relief and regain normal function. You have several treatment choices, including medication, surgery, and physical therapy. Physical therapy is a conservative treatment option for TOS. It addresses the root cause of the compression and pain and creates long-term relief from the condition.

You will benefit from our services at Suarez Physical Therapy if you seek expert physical therapy services for your TOS in Las Vegas, NV. Our expert physical therapy team creates personalized therapy plans to reduce pain, improve mobility, and prevent long-term damage.

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome arises when the nerves or blood vessels in the thoracic outlet are compressed. There are three main types of thoracic outlet syndrome. Different factors cause each type of TOS. They include the following:

Neurogenic Thoracic Outlet Syndrome (nTOS)

Neurogenic TOS is the most common form of thoracic outlet syndrome. It involves compression of the brachial plexus. The brachial plexus is a network of nerves that sends signals from the spinal cord to the shoulder and arm. The symptoms of nTOS include:

  • Pain in the neck, shoulder, or arm. If you have nTOS, you may experience a throbbing pain that increases when you elevate or extend the arms.
  • Numbness and tingling. These sensations occur in the arm and hand, particularly the fourth and fifth fingers.
  • Muscle weakness. Individuals affected by neurogenic thoracic outlet syndrome may notice weakness in the hand and arm. The muscle weakness makes tasks like gripping objects or lifting items difficult.
  • Loss of fine motor control. Activities that need precision, such as buttoning a shirt or writing, may become challenging for an individual with nTOS.
  • Muscle atrophy. In chronic cases, muscle shrinkage in the fleshy part of the hand near the thumb may occur.
  • Cold sensitivity. Some patients report increased sensitivity to cold temperatures, especially in the fingers.

Venous Thoracic Outlet Syndrome (vTOS)

Venous TOS involves compression of the subclavian vein. The symptoms of vTOS are related to impaired venous return and include:

  • Arm swelling. Swelling of the arms is the most common symptom of vTOS and often occurs after strenuous or repetitive arm activity.
  • Bluish discoloration. When you have vTOS, the affected arm may appear bluish or purplish due to poor blood flow.
  • Heaviness and aching. Patients with venous thoracic outlet syndrome experience a dull, heavy sensation in the arm that worsens with activity.
  • Visible veins. Enlarged veins may appear around the shoulder or upper chest when you have venous thoracic outlet syndrome.
  • Pain or tightness. Pain around the shoulder, upper chest, or arm, especially after prolonged use of the limb, is a common symptom of vTOS.
  • Clot formation. In severe cases, deep vein thrombosis (DVT) can develop. The clot formation causes increased swelling and tenderness in the arm.

Arterial Thoracic Outlet Syndrome (aTOS)

Arterial TOS is the rarest form of the condition. It occurs when the subclavian artery is compressed. The symptoms of aTOS are related to impaired arterial blood flow. They include:

  • Coldness of the hand or fingers. Cold hands and fingers indicate reduced arterial circulation caused by subclavian artery compression.
  • Weak or absent pulse in the affected arm. Your radial pulse may diminish or disappear when you stretch the affected arm.
  • Color changes. The hand may turn white or blue, especially when elevated or during cold exposure.
  • Pain and cramping. Cramping and pain in the forearm are common symptoms of arterial thoracic outlet syndrome.
  • Non-healing wounds or ulcers. Severe cases of aTOS may result in inadequate blood flow, leading to poor wound healing.
  • Numbness and tingling. Although these symptoms are common in neurogenic TOS, they can result from ischemia in arterial TOS.

Causes of Thoracic Outlet Syndrome

Thoracic outlet syndrome is characterized by the compression of nerves, arteries, or veins that pass through the thoracic outlet. Compression of these structures can result in pain, weakness, and swelling in the upper extremities. TOS can occur due to several causes, including:

Anatomical Abnormalities

Anatomical factors are a significant contributor to the development of TOS. These abnormalities create mechanical compression on the nerves or blood vessels in the thoracic outlet. They include:

  • Cervical rib. This is a congenital condition where an extra rib, called a cervical rib, is present above the first rib. The extra rib can compress the brachial plexus, leading to TOS. Although cervical rib is a rare condition, it is a known cause of thoracic outlet syndrome.
  • Abnormalities in the clavicle. Variations in the first rib's shape, size, or position can alter the space available in the thoracic outlet. For instance, a downward-sloping or elevated first rib can narrow the thoracic outlet.
  • Scalene Muscle Hypertrophy. The scalene muscles are located in the neck, and they are involved in the movement of the neck and upper limbs. If these muscles become enlarged or tense, they can compress the brachial plexus, leading to neurogenic TOS. Muscle hypertrophy can happen due to chronic muscle tension or repetitive neck movements.

Trauma or Injury

Injuries to the shoulder or neck region can damage the structures of the thoracic outlet. Trauma can alter the alignment of the bones and soft tissues in the area, leading to compression of the nerves. Common injuries responsible for TOS include:

  • Whiplash injury. The injury occurs when there is a sudden jerking movement of the head and neck, which is common in car accidents. The injury stretches or tears the neck's muscles, ligaments, and nerves. Whiplash can cause compression of the brachial plexus or subclavian vessels.
  • Fractures or dislocations. A fractured clavicle, rib, or shoulder dislocation can alter the position of the bones in the thoracic outlet. There is an increased likelihood of compression on the neurovascular structures when the thoracic outlet narrows.

Repetitive Movements and Overuse

TOS is standard in individuals who perform repetitive activities. Remaining in a single position for prolonged periods can compress the neurovascular structures in the thoracic outlet. Common instances of repetitive motion and overuse are:

  • Occupational hazards. Jobs requiring prolonged or repetitive overhead movements can strain the muscles and tendons in the neck. They include painters, carpenters, or athletes. Over time, the repetitive movements can lead to muscle hypertrophy or spasm. Muscle hypertrophy narrows the thoracic outlet and compresses the nerves and blood vessels.
  • Postural stress. Poor posture, such as forward head posture, can shorten and tighten neck and upper back muscles. This can contribute to TOS by narrowing the space through which the brachial plexus and blood vessels pass.

Pregnancy

Pregnancy can also contribute to the development of TOS. The increased weight of the uterus can affect the body's posture and mechanics. Hormonal changes during pregnancy can also cause ligaments and soft tissues to become more relaxed and prone to strain. In women with a prior predisposition to TOS, pregnancy can increase the pressure in the thoracic outlet.

Obesity

Obesity can worsen postural stress and muscle fatigue, which may aggravate existing thoracic outlet syndrome. The extra weight can lead to muscle fatigue and cause the muscles around the neck and shoulders to become tense.

Tumors and Other Growths

Tumors or growths in the thoracic outlet area can cause compression of the neurovascular structures. A tumor in the apex of the lung can compress the brachial plexus, leading to symptoms that mimic thoracic outlet syndrome. Additionally, benign growths like lipomas can compress the thoracic outlet structures.

Arthritis

Degenerative joint conditions like arthritis can lead to changes in the structure of the vertebrae and discs. The structural changes may cause compression of the neurovascular structures in the thoracic outlet, leading to TOS.

Treatment for Thoracic Outlet Syndrome

TOS causes severe pain and discomfort. The treatment options for the condition vary depending on the type and severity of the condition. They include:

Medications

Medications help manage pain and inflammation associated with TOS. Some of the medicines that your doctor can prescribe include:

  • Non-steroidal anti-inflammatory drugs. NSAIDs like ibuprofen or naproxen help reduce swelling and discomfort caused by thoracic outlet syndrome.
  • Muscle relaxants. Your doctor can prescribe muscle relaxants to reduce tension in the muscles.
  • Neuropathic pain medications. Drugs like amitriptyline can ease nerve-related pain in neurogenic TOS.

Lifestyle Modifications

Certain habits or activities can worsen TOS. Making lifestyle changes can help relieve the symptoms. Common lifestyle changes you can make include

  • Ergonomic adjustments. They improve workplace setups to avoid strain on the shoulders and neck.
  • Activity modification. You can avoid overhead movements like heavy lifting or repetitive arm actions.
  • Weight loss. Losing weight can reduce pressure on the thoracic outlet if you are overweight or obese.

Pain Management Techniques

If you are dealing with the pain and discomfort caused by thoracic outlet syndrome, you could benefit from additional therapies like:

  • Heat or ice therapy. It helps manage localized pain or inflammation.
  • Transcutaneous electrical nerve stimulation (TENS). TENS sends low-level electrical signals to help reduce nerve pain caused by thoracic outlet syndrome.
  • Massage therapy. Massage helps release muscle tightness that contributes to compression.

Surgical Treatments

Surgery is reserved for patients who do not respond to conservative treatments or who develop significant vascular compromise. The type of surgery suitable for your TOS depends on the cause and structures involved. Standard surgical procedures include:

First Rib Resection

The procedure involves the removal of the first rib to relieve compression in the thoracic outlet. A surgeon can perform teh procedure using the following approaches:

  • Transaxillary. The procedure is done through the armpit and is common for rib resection without extensive vascular involvement.
  • Supraclavicular. The surgeon removes the first rib through the neck above the collarbone. The approach provides better access to nerves and vessels.
  • Infraclavicular. This approach involves the removal of the rib from below the collarbone.

Scalenectomy

The procedure involves removing or cutting the scalene muscles, which are a source of compression. Scalenectomy is effective when tight scalene muscles are involved, and the surgeon can combine it with rib resection.

Physical Therapy for TOS

Physical therapy offers a common way to treat thoracic outlet syndrome. It aims to strengthen and stretch areas that play a role in nerve compression. Physical therapists often use these approaches to help with TOS:

  • Posture correction. Bad posture can lead to thoracic outlet syndrome. It can put more pressure on the thoracic outlet, squeezing nerves. Physical therapy begins by teaching good posture and fixing bad habits.
  • Scapular retraction. The physical therapist shows patients how to pull their shoulder blades back and down. Scapular retraction helps line things up better and eases pressure on the thoracic outlet.
  • Chin tucks. The exercise helps put the head and neck in the correct position. It also cuts down on stress to the neck muscles and nerves.
  • Postural awareness. The PT teaches patients how to maintain good posture during daily tasks. Knowing how to sit, drive, or stand at a desk can stop the condition from worsening.

Stretching Tight Muscles

In TOS, some muscles may become tight and worsen nerve compression. In this case, physical therapy focuses on stretching these muscles to increase the space in the thoracic outlet. The targeted muscles include:

  • Pectoralis major and minor. Tightness in the chest muscles is common in TOS. Stretching the pectoral muscles will help relieve pressure on the nerves and vessels.
  • Scalenes. When these neck muscles become tight, they compress the brachial plexus. Your physical therapist can include mobility exercises for the scalenes in your treatment plan.
  • Upper trapezius and levator scapulae. Stretching these muscles can improve neck mobility and reduce nerve impingement. You should stretch gradually to avoid further irritation of the nerves resulting from overstretching.

Strengthening Weak Muscles

Tight muscles are a common issue in TOS. However, weakened muscles can also contribute to the condition. This is because they cause neck and shoulder instability. Strengthening these muscles can help ease TOS symptoms:

  • Lower trapezius and serratus anterior. These muscles stabilize the shoulder blades. Strengthening them can reduce pressure on the thoracic outlet.
  • Rhomboids. Strengthening the rhomboids helps retract the shoulder blades and improve posture.
  • Core Muscles. A strong core supports overall posture. Additionally, it helps maintain proper alignment during daily activities, thus reducing strain on the thoracic outlet.

A competent physical therapist tailors the strengthening exercises to your specific needs. Sometimes, they will introduce progressive resistance to enhance muscle endurance and stability.

Nerve Gliding and Mobilization

Nerve gliding exercises are essential for patients with neurogenic TOS. These exercises help the nerves move smoothly through their respective tunnels. For example, when the brachial plexus is trapped, you can experience pain, tingling, and weakness in the arm and hand. Nerve gliding exercises help to mobilize these nerves and reduce compression.

Common examples of nerve gliding exercises include:

  • Median nerve gliding. Stretching the arm, wrist, and fingers while keeping the head and neck neutral can help mobilize the median nerve.
  • Radial nerve gliding. With this exercise, you will slowly extend and flex your arm to promote the movement of the radial nerve without causing excessive tension.

You must perform these exercises under the guidance of a physical therapist. The PT will ensure that the exercises suit your condition so you do not aggravate it.

Manual Therapy

Physical therapists use hands-on methods to ease tension and boost movement. These techniques help loosen tight muscles, increase blood flow, and take pressure off nerves. Common hands-on methods include:

  • Soft tissue work. It involves putting pressure on tight muscles near the thoracic outlet to help them relax.
  • Joint work. Careful movement of the neck bones can help remove blockages that add to TOS.

A certified physical therapist must do these hands-on techniques to avoid worsening your symptoms.

Education

Physical therapy for TOS goes beyond exercises and hands-on work. Teaching patients about lifestyle changes plays a significant role in treatment. This includes:

  • Setting up a good workspace. Your PT will guide you in setting up your work area to prevent strain on the thoracic outlet.
  • Body mechanics. Physical therapists show patients the right way to move and pick up things when lifting their arms over their heads.

Find Expert Physical Therapy Services Near Me

Thoracic outlet syndrome can cause pain, numbness, and weakness in the shoulder or arm. When you consult your doctor with these symptoms, they will perform different diagnostic tests to determine your TOS type. Various treatment options are available for TOS, including medication, surgery, lifestyle changes, and physical therapy.

If you seek a conservative option for the treatment of your thoracic outlet syndrome, your doctor can recommend physical therapy. Your physical therapist will tailor a program based on the severity of your condition. Initially, exercises may focus on gentle stretches and posture correction, and gradually move on to more strengthening activities.

If you are dealing with thoracic outlet syndrome, a competent physical therapist will help you create a personalized treatment plan. At Suarez Physical Therapy, we offer safe and reliable physical therapy services for our clients battling thoracic outlet syndrome. Contact us at 702-368-6778 from Las Vegas, NV, to book an appointment.