Thoracic outlet syndrome (TOS) is a group of disorders that occur when blood v
essels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause pain or aches in your neck, shoulder, arm or hand, Numbness or tingling in your arm or fingers.
Historically, TOS presents with symptom onset between the ages of 20–50 years old and is more prevalent in women
A systematic review by Sanders et al. described symptom distribution in neurogenic TOS to include upper extremity paresthesia (98%), neck pain (88%), trapezius pain (92%), shoulder and/or arm pain (88%), supraclavicular pain (76%), chest pain (72%), occipital headache (76%), and paresthesias in all five fingers (58%), the fourth and fifth fingers only (26%), or the first, second, and third fingers
Pain in the shoulder and neck
Ache in the arm or hand
Altered sensation in the arm
Numbness or tingling in any area from neck to arm, hands or fingers
Muscle weakness in the arm
Weakness with grip
TOS symptoms are similar to the symptoms of many other conditions. A herniated disc in the neck, carpal tunnel syndrome in the hand, and bursitis of the shoulder can all cause symptoms very much like those of TOS.
What are the causes of thoracic outlet syndrome
Slouching and drooping shoulders or forward head position can cause increased tension in the side neck muscles and stretching of the nerves, leading to compression in the thoracic outlet. Forward head posture, rounded shoulders, and a rounded thoracic back can decrease the space by which the nerves and blood vessels can travel. The poor body alignment of slouching can compress the nerves and arteries near the thoracic outlet. Being overweight can cause problems with posture
Traumatic events e.g. car accident causing injury, bony or soft tissue changes to the thoracic area.
Those involving repetitive overhead movements, prolonged typing on a computer, and poor lifting techniques can increase strain on tissues in the neck and shoulder to cause compression of the vascular and neural structures in the thoracic outlet.
Extra rib from the neck at birth (cervical rib) narrowing the thoracic outlet and increasing the susceptibility of compression. or an abnormally tight fibrous band that connects the spine to the rib
Increased muscle bulk at the neck and shoulders from weightlifting can increase susceptibility to compression of the thoracic outlet.
What can you do about it
If an individual is diagnosed with arterial or venous TOS, surgery is typically the only option due to the severity of the injury.
Surgical intervention for nTOS syndrome is reserved for patients who have failed conservative management. Conservative treatment including physical therapy need be trailed for at least 4–6 months prior to consideration of surgical intervention
a 4-6 months long physical therapy program will include stretches to improve flexibility, massage therapy to reduce pain, exercises to strengthen the region, and education on strategies to improve the health of the nerves and arteries located in the thoracic outlet.
Strengthening exercises alone will not alter the pathophysiology of TOS; a combination of strengthening, stretching, and postural adjustments must all be incorporated for improvements to be observed.
A home exercise program is essential to the treatment of TOS. This is true even if the cause of your TOS is an abnormality in the bones and muscles. You must consistently do your exercises to get the most benefit.
Thoracic extension, can help to open up the chest, improving breathing and reducing tightness and pain in surrounding joints, is extremely important for the health of your neck, shoulders, and arms.
LittleMum Trapezius Massager is recommended to help with TOS. This can help with:
Loosening up tight muscles and joints of the upper back and back which is around the compressed nerves and blood vessels
Releasing the surrounding soft tissue mobilizing adjacent joints, giving you stretches for muscles and nerves
Obtaining better range of motion in your neck and upper back
Stretching the muscles in the front of the chest
LittleMum Trapezius Massager is sturdy, highly resilience when compressed to loosen up your neck and upper back tight muscles. It lifts your head to support your neck in the aligned position to stretch the muscles in the front of the chest.
Lay on a LittleMum Trazpies massager with it going right down your spine and with your neck supported. Your feet should be flat on the ground with your knees bent. Bring your arms up and out at the side with your palms up. Let gravity pull your arms down creating a stretch in your chest. You will feel a deep stretch in your chest muscles while releasing your upper back and neck muscles.
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Posture correction and education on self-management are important as well to promote restoration of function. Patients with Thoracic Outlet Syndrome need to regularly be conscious of their posture.
Adjust the chair height so your feet are flat on the floor and your knees are in line (or slightly lower) with your hips. Sit up straight and keep your hips far back in the chair. The back of the chair should be somewhat reclined at a 100- to 110-degree angle.