Thoracic Outlet Syndrome Treatment

Types of Thoracic Outlet Syndrome

Understanding the specific type of TOS you have is crucial for effective treatment, as each form involves different compressed structures and requires a tailored approach. The symptoms can vary significantly based on whether nerves, veins, or arteries are affected.

Neurogenic (Neurological) TOS

This is the most common form, accounting for over 90% of cases. It occurs when the brachial plexus, a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm, and hand, is compressed. Symptoms are often sensory and motor in nature, including pain, aching, tingling, or numbness that can radiate from the neck down the arm into the fingers. Patients may also experience a weakened grip, fatigue in the arm with overhead activities, or notice muscle wasting at the base of the thumb.

Venous TOS

This type results from the compression of the subclavian vein, a major vein that runs through the thoracic outlet. This compression can lead to blood clots (deep vein thrombosis or DVT) in the upper body. Symptoms often appear suddenly and can include significant swelling (edema) in the entire arm, a feeling of heaviness or fatigue, and a bluish, dusky discoloration of the hand and arm (cyanosis). A network of prominent veins may also become visible across the chest and shoulder. Venous TOS is a serious condition that requires prompt medical attention.

Arterial TOS

The rarest and most serious form, arterial TOS happens when the subclavian artery is compressed. This compression is often caused by a bony abnormality, such as a cervical rib. It can cause an aneurysm (a bulge in the artery wall) or lead to blood clots that travel down into the hand and fingers. Symptoms include coldness, paleness, or poor circulation in the arm and hand, pain that worsens with activity, non-healing sores (ulcers) on the fingers, and a weak or absent pulse in the wrist. Arterial TOS is a medical emergency requiring immediate evaluation.

The Diagnosis Process for Thoracic Outlet Syndrome

Accurately diagnosing TOS can be complex because its symptoms often mimic other conditions like carpal tunnel syndrome, rotator cuff injuries, or cervical disc herniation. A thorough evaluation by a qualified healthcare professional, such as a physiotherapist, is essential for an accurate diagnosis.

Comprehensive Physical Examination

Your physiotherapist will begin by discussing your medical history, symptoms, occupation, and daily activities to identify potential contributing factors. They will perform a physical exam to check for any signs of TOS, such as tenderness over the scalene muscles or under the collarbone, limited range of motion in the neck and shoulder, or discernible muscle weakness and atrophy. Postural assessment is key, as a forward head and rounded shoulders posture significantly narrows the thoracic outlet space.

Provocative Testing (Special Tests)

To pinpoint the compression, specific thoracic outlet syndrome special tests are used. These tests are manoeuvres designed to intentionally, but safely, narrow the thoracic outlet to see if they reproduce your specific symptoms. The Roos test, also known as the elevated arm stress test, involves holding both arms up and out, then rapidly opening and closing your hands for up to three minutes. The inability to complete the test or the onset of your symptoms is a positive sign. The Wright's test checks for changes in your radial pulse when your arm is moved into different elevated and rotated positions. These thoracic outlet syndrome tests, including the Wright test for thoracic outlet syndrome and the Roos test for thoracic outlet, are vital diagnostic tools when interpreted within the context of a full examination.

Advanced Imaging and Studies

In some cases, further tests may be ordered to confirm the diagnosis and rule out other issues. A thoracic outlet syndrome ultrasound (Doppler ultrasound) is a non-invasive test that uses sound waves to visualise blood flow and can detect compression of the subclavian vein or artery. X-rays can identify bony abnormalities like a cervical rib, while advanced imaging like MRI or CT scans can provide detailed views of the soft tissues and brachial plexus nerves.

Treatment and Management of Thoracic Outlet Syndrome

The primary goal of thoracic outlet syndrome treatment is to relieve the pressure on the affected nerves or blood vessels, thereby alleviating symptoms and restoring function. For most people with neurogenic TOS, a conservative, non-surgical approach is highly effective.

The Core Role of Rehabilitation

Rehabilitation is the cornerstone of managing TOS. A structured program focusing on thoracic outlet syndrome physiotherapy helps create more space in the thoracic outlet by correcting postural imbalances, stretching tight muscles, and strengthening weak ones. This multi-faceted approach addresses the root biomechanical causes of the compression, offering a long-term solution rather than just temporary symptom relief.

Conservative Treatment Options

Beyond physiotherapy, initial treatment often involves activity and lifestyle modifications. This may include adjusting your workspace ergonomics, taking frequent breaks from repetitive tasks, and avoiding carrying heavy bags on your shoulder. Over-the-counter anti-inflammatory medications can help manage discomfort in the short term, but they do not address the underlying compression and should be used as part of a comprehensive treatment plan.

Professional Manual Therapies

Treatment for thoracic outlet syndrome and chiropractic care can be beneficial when used appropriately. Chiropractors and specially trained physiotherapists use manual, hands-on techniques to improve joint mobility in the first rib, the clavicle (collarbone), and the cervical and thoracic spine. Mobilising these structures can directly increase the space within the thoracic outlet, providing immediate relief from nerve or vessel pressure.

How Physical Therapy Transforms Thoracic Outlet Syndrome Recovery

Physical therapy for thoracic outlet syndrome is the most widely recommended and effective non-surgical treatment. A customised plan at Physiotattva targets the root cause of the compression by systematically restoring normal biomechanics to the neck and shoulder girdle.

Targeted Stretching Exercises

Tight, shortened muscles are a primary contributor to compression in the thoracic outlet. The scalene muscles in the neck and the pectoralis minor muscle in the chest are often the main culprits. Your physiotherapist will teach you safe and effective stretches to lengthen these specific muscles. Performing these stretches consistently helps to lift the clavicle and open up the costoclavicular space, directly decompressing the neurovascular bundle.

Strengthening and Stabilisation

Weakness in the muscles that support the shoulder blades (scapulae) and maintain upright posture is another key factor. A drooping shoulder posture narrows the thoracic outlet. A program of thoracic outlet syndrome exercises will focus on strengthening the mid and lower trapezius, rhomboids, and serratus anterior muscles. Strengthening these muscles helps to retract and stabilise the shoulder blades, promoting a more open and neutral posture.

Postural Correction and Education

A significant and lasting part of thoracic outlet syndrome therapy involves education. You cannot exercise your way out of a problem that is reinforced by 8 hours of poor posture each day. Your therapist will provide crucial education on body mechanics and ergonomics for your desk setup, driving, sleeping positions, and daily activities. Learning to maintain a neutral spine and an open chest posture is fundamental for preventing the recurrence of symptoms.

Manual Therapy Techniques

Hands-on techniques are a critical component of a successful recovery. Your physiotherapist will use soft tissue massage and myofascial release to decrease tension in the scalene, pectoral, and other surrounding muscles. They will also perform specific joint mobilisations for the first rib, clavicle, and thoracic vertebrae. This hands-on part of our thoracic outlet syndrome physiotherapy treatment is essential for manually creating space, improving mobility, and accelerating pain relief.

Begin Your Path to Lasting Relief with Physiotattva's Expert Treatment

Thoracic Outlet Syndrome can be a painful and frustrating condition, but it is manageable with the right approach. A timely and accurate diagnosis is the first step toward recovery. For the majority of individuals, a dedicated thoracic outlet syndrome physiotherapy program provides the most effective path to lasting relief. By addressing muscle imbalances, improving posture, and increasing space within the thoracic outlet, physiotherapy not only treats the symptoms but also corrects the underlying issue.

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.