Clinical Conversations

Thoracic Outlet Syndrome – TOS

Recently, I have had 3 physical therapy patients in the clinic with a complicated clinical presentation.  All 3 patients have a different cluster of symptoms and impairments. What they each have in common is that they have upper extremity symptoms that are not of cervical spine (radiculopathy) origin.  Instead, their pathology is a result of tight chest and neck musculature, compressing the bundle of nerves that control the movement and sensation of the arm.  Clinically, this is known as Thoracic Outlet Syndrome, or, TOS.

What is Thoracic Outlet Syndrome?

  • Compression of the artery, vein and/or nerves that pass through the thoracic outlet.
  • There are 3 possible locations for the compression to occur:
    • In between your scalene (neck muscles)
    • In between the clavicle and first rib
    • Under the peck minor (chest muscle)
The most common compression is of the nerves.  This results in vague pain of the arm as well as various sensations: itchy, hot, cold, pins and needles, etc.It may be painful to the touch for any of the muscles involved with the compression.

Poor posture as well as decreased flexibility of the thoracic spine are also associated with TOS.

Rarely, an extra rib (cervical rib) is the cause.

Image of muscle and skeletal region affected by TOS


Physical Therapy Treatment for TOS

  • Physical therapy is the first line of treatment for Thoracic Outlet Syndrome (TOS).
  • A therapist will teach you how to stretch what needs to be lengthened as well as how to strengthen muscles that will improve posture.
  • Physical therapists also have manual techniques to help you progress your treatment
  • Most people diagnosed with TOS  have a good prognosis and will have complete resolution of symptoms with conservative treatment only.