Thoracic Outlet Syndrome (TOS)

Recognising the Key Signs and Symptoms of Thoracic Outlet Syndrome

The specific signs you experience often depend on whether nerves or blood vessels are being compressed. Since over 90% of cases are neurogenic (involving nerves), these symptoms are the most common. It's crucial to pay attention to these signals your body is sending, as they can be intermittent at first but may become constant over time.

Neurological Symptoms (Nerve Compression)

This is the most prevalent form of TOS. You may notice numbness, tingling, or a pins-and-needles sensation, particularly in your arm, hand, and especially the fourth and fifth fingers. These Thoracic Outlet Syndrome (TOS) symptoms, which can come and go, may also include a dull ache in the neck, shoulder, or armpit.

Vascular Symptoms (Blood Vessel Compression)

Less common but more serious, vascular TOS involves the compression of an artery or vein. Symptoms include swelling in the arm or hand, a bluish discoloration of the skin (cyanosis), a feeling of coldness in the hands and fingers, and a weak or absent pulse in the affected arm. These signs require prompt medical attention.

Specific Pain Patterns and Weakness

Patients often report pain that radiates from the neck and shoulder down the arm. A common complaint is thoracic outlet syndrome symptoms at night, which can worsen due to sleeping positions that increase compression. Over time, persistent nerve compression can lead to a weakened grip, making it difficult to perform daily tasks like opening a jar or holding a pen.

Advanced Signs like Muscle Atrophy

In severe or chronic cases, you might notice thoracic outlet syndrome muscle wasting, particularly in the fleshy base of the thumb (known as Gilliatt-Sumner hand). This is a significant sign indicating long-term nerve damage and requires immediate medical evaluation to prevent permanent functional loss.

Causes of Thoracic Outlet Syndrome

Understanding the reasons for Thoracic Outlet Syndrome is key to both treatment and prevention. The condition arises from anything that narrows the thoracic outlet, putting pressure on the vital structures passing through it.

Traumatic Injury

A sudden injury from a car accident (like whiplash), a fall, or a sports-related collision can cause fractures or inflammation that alters the anatomy of the thoracic outlet. This post-traumatic inflammation is a significant one of the thoracic outlet syndrome causes, as it can lead to scarring and chronic compression.

Repetitive Strain and Overuse

Jobs or activities that involve repetitive overhead movements, such as swimming, painting, stocking shelves, or lifting heavy objects, can lead to inflammation and strain on the muscles and ligaments around the thoracic outlet, contributing to Thoracic Outlet Syndrome (TOS) symptoms.

Poor Posture

This is one of the most common and modifiable causes of Thoracic Outlet Syndrome. Consistently slouching or holding your head in a forward position (often called "tech neck") can cause your shoulders to droop and your collarbone to compress the underlying nerves and blood vessels, leading to chronic symptoms.

Anatomical Variations

Some individuals are born with anatomical differences that predispose them to this condition. This can include having an extra first rib (a cervical rib), unusually tight fibrous bands near the brachial plexus nerves, or even changes during pregnancy, which can cause temporary narrowing of the space due to fluid retention and postural shifts.

How Physiotherapy Helps Manage Thoracic Outlet Syndrome Symptoms

Physiotherapy is the cornerstone of conservative treatment for TOS. The goal is not just to alleviate pain but to address the root causes of the compression. At Physiotattva, our physiotherapists create personalized plans to restore function and prevent recurrence.

Postural Re-education and Ergonomics

A therapist will assess your posture and guide you on how to maintain proper alignment during daily activities. This includes teaching you ergonomic principles for your workspace to reduce strain on your neck and shoulders, directly countering one of the primary reasons for Thoracic Outlet Syndrome.

Targeted Stretching and Nerve Gliding

Gentle stretching exercises are prescribed to loosen tight muscles in the chest (pectorals) and neck (scalenes) that contribute to compression. A classic example is the doorway stretch for the pectoral muscles. Nerve gliding, or neural flossing, techniques are also used to help the nerves move more freely through the thoracic outlet, reducing irritation.

Strengthening Key Muscle Groups

Weakness in the upper back and shoulder blade muscles (scapular stabilizers) can worsen poor posture. A physiotherapist will guide you through specific exercises to strengthen muscles like the rhomboids and serratus anterior, which help open up the thoracic outlet space by improving shoulder positioning.

Guidance on Sleep and Activity Modification

To manage symptoms at night, your therapist will advise on the best thoracic outlet syndrome sleeping position, typically on your back or unaffected side with pillows for support. They will also help you modify activities that trigger your symptoms. While some people report thoracic outlet syndrome and heart palpitations, these are often related to the anxiety symptoms that can cause. Your physiotherapist can teach you breathing techniques to help manage this.

Supporting Recovery From Thoracic Outlet Syndrome With Physiotattva

Thoracic Outlet Syndrome can be a challenging and disruptive condition, but it is highly manageable. Recognising the thoracic outlet syndrome symptoms early and understanding the various thoracic outlet syndrome causes and symptoms empowers you to take control. With a proactive approach centered on expert physiotherapy, you can effectively address the underlying issues, alleviate pain, and restore your quality of life. If you're ready to take the next step, contact a specialist to create a personalized treatment plan designed to open up space, reduce pressure, and help you move freely again.

At Physiotattva physiotherapy clinics in Bangalore and Hyderabad, you receive personalised care tailored to your specific needs, ensuring effective results and comfort throughout your journey to recovery. 

Don’t wait to start your recovery! Get in touch with Physiotattva for more details! Contact us at +91 89510 47001.