Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a condition that is characterised by pain and change in sensation in the upper back (thoracic spine) shoulder, arm and hand. This can include pins and needles, numbness and change in temperature in the arm. It is also possible to have aching, sharp pain or heaviness in the arm and back.

Nerves exit the spine from the neck and upper back which lead into the arm. The nerves from each vertebrae supplies a different part of the arm or hand with sensation and muscle power. It passes through the thoracic outlet at the shoulder and this is where the problem is with this condition. The thoracic outlet is made up of the collar bone, spinal muscles, the first rib and blood vessels. Compression of the nerves and/or blood vessels at the Thoracic outlet causes nerve inflammation. It also changes how well the nerve messages are sent therefore causing pain and changes in sensation in the arm.

Trained and experienced Physiotherapists at Pure Physiotherapy see and deal with this condition very regularly. With a multi-angled approach, it is possible to ease your symptoms and regain your normal function again as well as prevent re-occurrence of this problem.

Neurogenic – compression and inflammation of the nerves

Vascular – compression of the arteries or veins

• Repetitive arm movement
• Extreme arm positions
• Sports injury
• Road traffic accident
• Anomalies in the neck muscles
• Abnormalities in the first rib
• Defects in the vertebrae in the neck
• Abnormalities in the chest muscles

This condition normally takes between 6 weeks and 12 months, although normally it is on the lower end of this. This condition normally gets better by itself but can be very painful and debilitating. You can have muscle weakness and/or imbalances due to this problem. One of the roles of Physiotherapy is to identify any strength or movement problems and address these in order to reduce the chance of it happening again.

It affects those between 20 and 50 years old generally. More women than men statistically are affected by TOS. Commonly it starts gradually without known reason but other causes of this problem are trauma including road traffic accident or sporting injury. Long standing muscle imbalance or weakness in a particular muscle group can also lead to this problem.

It is helpful to see a Physiotherapist to get an accurate and quick diagnosis. Then it is possible to devise a plan to best combat this condition specific to your lifestyle. It is most effective when diagnosed within 6 weeks of when the problem started. With any condition a subjective assessment and a physical assessment is done by the Physiotherapist. Approximately 90% of the diagnosis comes from the subjective assessment where aggravating and easing factors and characteristics of your problem are discussed. Specific and neurological tests are done in the physical exam to test the physiological structures and rule out other Musculoskeletal problems. Sometimes but not often it is required to have further investigations to help with this diagnosis. If this is required, the Physiotherapist can refer you to your doctor or specialist to arrange an X-ray or MRI scan.

At Pure Physiotherapy, TOS is a condition that is seen regularly and treated effectively and quickly. We, at Pure Physiotherapy feel it is important to cater a treatment plan to get the best results for the patient and use the grade of treatment appropriate for you. The following treatment approaches are normally used for this problem:

• A specific progressive exercise program
• Joint mobilisations
• Trigger point therapy
• Massage
• Nerve mobilisation
• Acupuncture
• Lifestyle and postural advice

Through the anticipated injury healing time, specific exercises will help to change pain generation and restore the health of the injured structures. Movement and strengthening promotes healthy blood flow and nutrients supply as well as addressing any muscle weakness.