Thoracic Outlet

Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) consists of a group of distinct disorders that affect the nerves in the brachial plexus (nerves that pass into the arms from the neck) and various nerves and blood vessels between the base of the neck and axilla (armpit).

Types of Thoracic Outlet Syndrome

  • True Neurologic
  • Disputed TOS
  • Arterial TOS
  • Venous TOS
  • Traumatic TOS


  • Inborn – cervical rib, anomalies of first rib.
  • Acquired – Laxity of muscles due to aging, obesity, postural abnormality, trauma, repetitive strain and laxity.
  • Others – Psychological disorder
            – Sleep disorder
            – Hormonal imbalance
            – Nutritional deficiency
            – Fibromyalgia
            – Mechanical disorder
            – Occupational hazards like electricians, painters, teachers, porters, cover
            – Head activities
            – Sports activities like tennis, volleyball, swimming and basket ball

Symptoms of Thoracic Outlet Syndrome

  • Numbness of the entire arm and hand ,ain and numbness can be constant or intermittent,
  • Deep ache or pain in the arms or shoulders is also characteristic of this syndrome.
  • Loss of circulation in the arm and hand, in some cases, the hands or fingers will turn blue or white in color, or they will get cold due to restricted circulation
  • Sleep patterns are often disturbed in many cases of TOS.
  • Shortened neck muscles can lead to compression of the neck vertebrae.
  • Restricted breathing may also be a troubling symptom. As the scalene muscles shorten,

Treatment for Thoracic Outlet Syndrome

Phase I – This phase consists of

  • Myotherapy soft tissue mobilization
  • Neural mobilization, rib mobilization
  • Clavicular mobilization
  • Scapula thoracic mobilization and physiotherapeutic modalities like IFT, US followed by assisted stretches.

Phase II – IFT, TENS, US

  • self stretching
  • exercises range of motion exercises,
  • relaxing techniques like breathing exercises,
  • Myotherapy soft tissue mobilization

Phase III – This phase continues with

  • self stretching exercises,
  • free exercises,
  • Progressive strengthening exercises followed by relaxation techniques.

Phase IV – This phase consists of

  • Postural maintenance
  • Whole body stretching and strengthening exercises in order to maintain strength of muscle.
  • Adequate micro and macro brakes should be taken in between work
  • Do the stretches and strengthening exercise at least five days a week