What is Thoracic Outlet Syndrome (TOS)?
Thoracic outlet syndrome (TOS) is a condition where neurovascular structures (nerves and blood vessels) become compressed as they pass beneath the first rib to reach the arm. The affected structures can include the subclavian artery, subclavian vein, or the brachial plexus, a network of nerves originating from the neck and supplying the arm. TOS is categorized into two types: neurological TOS affecting nerves of the brachial plexus in 95-99% of cases, and vascular TOS affecting arteries or veins in 1-5% of cases.
Who is at risk?
Certain anatomical variations like an extra cervical rib, congenital muscular abnormalities, or stiffness in clavicular and costal areas can contribute to TOS. Approximately 8% of the population experiences TOS, with a higher prevalence (3-4 times more) among individuals aged 20-50 years, particularly affecting women more than men. Postural factors, such as shortened pectoralis muscles and drooping shoulders, along with muscular imbalances and repetitive stress injuries, can also lead to TOS. Certain sports that involve repetitive overhead movements, like tennis, baseball, or swimming, can increase the risk due to compression of neurovascular structures.
What are the symptoms?
Neurological TOS typically presents with mild pain from the neck to the hands, along with sensory changes like decreased sensation, arm heaviness, numbness, tingling, or weakness in the arms.
Vascular TOS can cause increased arm pressure due to the compression of blood vessels, sensation of heaviness, changes in arm color or temperature, and arm swelling.
How can physiotherapy help?
Physiotherapy is highly beneficial for managing TOS symptoms by improving mobility and providing essential education. Treatment focuses on postural correction, scapular and neck positioning, releasing muscular tightness (especially in the pectoralis), and mobilizing stiff nearby joints. For cases where physiotherapy alone isn’t sufficient, especially in Venous TOS, surgical intervention may be recommended. In such cases, postoperative rehabilitation is crucial to prevent complications like scar tissue adhesions and to address posture issues that could continue to compress affected structures.
For a detailed rehabilitation plan and exercise program, consult with your physiotherapist.
