Thoracic outlet syndrome

Thoracic outlet syndrome (TOS)

Thoracic outlet syndrome(TOS) is a condition where your nerves, arteries or veins leading from the root of your neck get compressed in between a muscle called as scalene muscle and the first rib or between the collar bone and first rib in your neck or in pectoral muscles on your upper chest wall. Occasional an extra rib (cervical rib) can cause similar symptoms.

Thoracic outlet syndrome(TOS) Cause

Presence of an extra rib or cervical rib

Postural variations like forward head posture

Postural stress like carrying a heavy suitcase.

Respiratory conditions where you over use your scalene muscle in your neck to help you to breath.

Collar bone fractures or in shoulder joint dislocations.

Sacring in your pectoral or upper chest muscles.

Thoracic outlet syndrome(TOS) Symptoms

Symptoms varies from one person to another, depending on the location of nerve or vessels compressed or severity of compression. There may be pain on the face, neck, shoulder which spreads in to your arm, temporary loss of feeling, tingling or weakness in the affected arm and fingers, temporary inability to do fine hand movements like doing up buttons, cold intolerance in your hands and rarely swelling in the affected arm. There may temporary skin discolouration and temperature changes. Symptoms may get worst while lifting or carrying heavy objects.

The other symptoms are sleep disturbances due to arm or neck posture, inability to maintain prolonged overhead reaching, computer work or driving.

Thoracic outlet syndrome(TOS) Treatment

This symptom is usually managed with conservative treatment as the results of surgery is not predictable. Conservative management includes Physiotherapy and massage therapy. Initial management in Physiotherapy is focussed on symptom management through educating you regarding posture, breathing exercises and sleeping postures to avoid compression. Once the symptoms are controlled treatment is then focussed on range of motion exercises, strengthening, stretching of tight structures, manual therapy and aerobic exercises. Surgery is indicated in limb threatening complications of TOS.