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Thoracic Outlet Syndrome


Thoracic Outlet Syndrome (TOS) is a condition defined by the compression of blood vessels or nerves in the thoracic outlet, a confined space between the first rib and the collarbone. The neck, shoulder, arm, and hand may experience discomfort, numbness, tingling, and weakness as a result of this compression. In this blog, we will explore the definition, causes, prevention strategies, and treatment options, including the role of physical therapy, for Thoracic Outlet Syndrome.


Definition of Thoracic Outlet Syndrome

Thoracic Outlet Syndrome refers to a group of disorders that result from the compression, irritation, or injury of the nerves or blood vessels in the thoracic outlet region. The thoracic outlet acts as a passageway for important nerves and blood vessels, including the brachial plexus and subclavian artery and vein. When these structures are compressed or irritated, it can lead to a range of symptoms.


  1. Shoulder and neck pain: Pain in the shoulder and neck region is one of the most common symptoms of TOS. The pain may be sharp, burning, or aching in nature and can radiate down the arm.
  2. Arm and hand numbness or tingling: Numbness or tingling sensations in the arm, forearm, hand, or fingers are frequently reported by individuals with TOS. This can occur intermittently or persistently.
  3. Weakness in the arm or hand: TOS can cause weakness or a feeling of heaviness in the affected arm or hand. This can lead to difficulty with gripping objects, dropping things, or decreased hand coordination.
  4. Coldness or discoloration of the hand or fingers: Some individuals with TOS may experience coldness, paleness, or bluish discoloration of the hand or fingers due to compromised blood flow.
  5. Swelling or puffiness in the arm or hand: Compression of the blood vessels can result in fluid buildup, leading to swelling or puffiness in the affected arm or hand.
  6. Headaches: In certain cases, TOS can cause headaches, particularly in the back of the head, neck, or temple region. These headaches may be accompanied by neck pain.
  7. Limited range of motion: TOS can restrict the normal range of motion of the shoulder and neck. Movements such as raising the arm, reaching overhead, or rotating the head may be limited or painful.
  8. Muscle atrophy: In chronic cases or severe TOS, muscle wasting or atrophy may occur, leading to visible changes in the affected arm or hand.

It is important to note that symptoms may vary among individuals, and not all individuals with TOS experience the same set of symptoms.


Causes of Thoracic Outlet Syndrome

Several factors can contribute to the development of TOS:

  • Poor posture and muscle imbalances: Rounded shoulders, forward head posture, and weak muscles in the neck and shoulder region can increase the risk of compression in the thoracic outlet.
  • Repetitive movements: Engaging in repetitive activities such as typing, carrying heavy loads, or participating in sports that involve repetitive arm movements can contribute to TOS.
  • Trauma: A direct injury, such as a car accident or repetitive stress injuries from activities like heavy lifting or overhead work, can lead to TOS.
  • Anatomical variations: Some individuals may have naturally occurring anatomical variations, such as a cervical rib or an abnormal first rib, which can contribute to compression in the thoracic outlet.


Prevention Strategies

While some risk factors for TOS may be beyond our control, adopting healthy habits and practicing good ergonomics can help reduce the likelihood of developing the condition:

  • Maintain good posture: Engage in exercises to strengthen the neck, shoulder, and upper back muscles, promoting proper alignment and reducing the strain on the thoracic outlet.
  • Take regular breaks: If your work involves repetitive tasks or prolonged sitting, take frequent breaks to stretch, change positions, and relieve tension in the neck and shoulders.
  • Ergonomic adjustments: Ensure that your workspace is set up ergonomically, with proper chair height, desk setup, and computer monitor position.


Treatment Approaches

Treatment for TOS may involve a multidisciplinary approach, and the specific approach will depend on the type and severity of the condition:

  1. Physical therapy: Physical therapy plays a crucial role in the management of TOS. A physical therapist can design a customized treatment plan that includes stretching and strengthening exercises to improve posture, increase flexibility, and relieve pressure on the thoracic outlet.
  2. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation associated with TOS. In some cases, muscle relaxants or nerve pain medications may also be prescribed.
  3. Lifestyle modifications: Simple changes like adjusting workstations, avoiding heavy lifting, and maintaining good posture can provide relief from TOS symptoms.
  4. Surgical intervention: In severe cases or when conservative treatments fail, surgery may be recommended to decompress the affected nerves or blood vessels.


Physical Therapy Management

Physical therapists employ various techniques to manage TOS effectively:

  • Postural correction exercises: Strengthening exercises for the neck, shoulder, and upper back muscles can improve posture, alleviate tension, and reduce compression in the thoracic outlet.
  • Stretching and mobility exercises: Gentle stretches and mobility exercises help increase range of motion, reduce muscle tightness, and improve overall flexibility.
  • Nerve gliding techniques: Specific exercises that involve controlled movement of the nerves can help alleviate nerve compression and reduce symptoms.
  • Manual therapy: Hands-on techniques, such as myofascial release, joint mobilization, can help release muscle tension, improve blood flow, and reduce compression in the thoracic outlet.


Neck Stretches

Start Position

End Position

  • Place your hands overlapping on your breast bone.
  • From a flexed position, tilt your head upward until a gentle stretch is felt along the front on the neck.
  • Hold for 45 seconds, then return slowly to start position.


Start Position

End Position

  • Place one hand on your breast bone.
  • From a flexed position, tilt your head upward and away from the affected area until a gentle stretch is felt along the front and side of the neck.
  • Hold for 45 seconds, then return slowly to start position


 Median Nerve Stech:

Start Position

End Position

  • Place your arm at 90 degree Abduction.
  • From a flexed position, extend your elbow then gently extend your wrist to feel a stretch
  • Do a set of 10 repetitions.


Ulnar Nerve Stretch:

Starting Position

End Position

  • Place your arm at 90 degree Abduction.
  • Elbow flexed and hand rotated placed on the ear.
  • From this position extend your elbow and flex the wrist until you feel a stretch.
  • Do a set of 10 repetitions.



Thoracic Outlet Syndrome can significantly impact an individual’s quality of life, but with proper understanding, prevention strategies, and appropriate treatment approaches, individuals can effectively manage the condition.

If you experience symptoms of TOS, consult a healthcare professional, including a physical therapist, for a comprehensive evaluation and personalized treatment plan to alleviate pain, restore function, and improve your overall well-being.



  1. Freischlag JA. Current management of thoracic outlet syndrome. Ann Vasc Surg. 2011;25(3):439-455.
  2. Laulan J, Fouquet B, Rodaix C, Jauffret P, Roquelaure Y, Descatha A. Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact. J Occup Rehabil. 2011;21(3):366-373.
  3. Oksuz C, Akkaya N, Koktener A, et al. Effectiveness of physical therapy and physical therapy plus hand ergotherapy treatment in women with thoracic outlet syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2010;91(4):604-609.


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