Understanding Thoracic Outlet Syndrome (TOS)
Do you experience pain, numbness, tingling, or weakness in your neck, shoulder, arm, or hand? If so, you might be suffering from Thoracic Outlet Syndrome (TOS)—a condition caused by the compression of nerves, arteries, or veins in the thoracic outlet (the narrow passage between the collarbone and first rib).
At Adaptive Physiotherapy & Massage in Booragoon, we specialize in evidence-based treatment for TOS, combining manual therapy, postural retraining, and specific rehabilitation exercises to help you regain pain-free movement and prevent recurrence.
This guide will explore what TOS is, its symptoms, and the best physiotherapy treatments to help you return to full function.
What is Thoracic Outlet Syndrome?
TOS occurs when nerves or blood vessels passing through the thoracic outlet become compressed, leading to neurological or vascular dysfunction in the arm and hand.
Types of Thoracic Outlet Syndrome
✔ Neurogenic TOS (nTOS) – The most common type, affecting the brachial plexus (nerve bundle supplying the arm and hand). Causes pain, numbness, tingling, and weakness.
✔ Venous TOS (vTOS) – Compression of the subclavian vein, leading to arm swelling, discoloration, and deep vein thrombosis (DVT) risk.
✔ Arterial TOS (aTOS) – The least common but most serious type, affecting the subclavian artery, leading to cold hands, poor circulation, and potential clot formation.
Common Causes of Thoracic Outlet Syndrome
🔹 Poor Posture – Forward head posture and rounded shoulders contribute to nerve and vascular compression.
🔹 Repetitive Overhead Movements – Sports like swimming, baseball, and weightlifting place excess strain on the thoracic outlet.
🔹 Muscle Imbalances – Tight pectoralis minor, scalenes, and upper trapezius, combined with weak deep neck flexors and scapular stabilizers, worsen compression.
🔹 Trauma – Whiplash, collarbone fractures, and repetitive strain injuries alter thoracic outlet mechanics.
🔹 Cervical Rib or Bony Abnormalities – Some individuals have extra ribs or bony structures that narrow the thoracic outlet.
Symptoms of Thoracic Outlet Syndrome
✅ Pain in the neck, shoulder, and arm (worsening with prolonged sitting, overhead activity, or carrying heavy objects).
✅ Numbness, tingling, or weakness in the hand and fingers (especially in the fourth and fifth digits).
✅ Coldness or discoloration in the arm or hand (suggesting vascular involvement).
✅ Swelling in the arm or heaviness (seen in venous TOS).
At Adaptive Physiotherapy & Massage in Booragoon, we conduct comprehensive assessments, including postural analysis, nerve testing, and movement screening, to diagnose the specific type of TOS and develop a tailored treatment plan.
Lisa’s Journey with Thoracic Outlet Syndrome
Lisa, a 38-year-old office worker, had been experiencing persistent numbness and tingling in her right arm for months. At first, she thought it was just from long hours at the computer, but when she started experiencing weakness in her grip and occasional coldness in her hand, she knew something was wrong.
After visiting Adaptive Physiotherapy & Massage in Booragoon, Lisa was diagnosed with Neurogenic Thoracic Outlet Syndrome (nTOS) caused by poor posture, tight pectoral muscles, and weak scapular stabilizers. Her treatment plan included:
✔ Manual therapy to release tight pectoral and scalene muscles.
✔ Postural retraining to correct forward head positioning.
✔ Strengthening exercises for scapular stability and deep neck flexors.
✔ Nerve gliding techniques to improve brachial plexus mobility.
Within six weeks, Lisa noticed a significant reduction in symptoms. After twelve weeks, she was able to return to work pain-free, with better posture and improved strength—a true testament to how physiotherapy can make a real difference.
Evidence-Based Treatment for Thoracic Outlet Syndrome
Treatment of Thoracic Outlet Syndrome focuses on reducing compression, restoring mobility, and strengthening stabilizing muscles.
1. Activity Modification & Postural Correction
✔ Avoid Prolonged Overhead Activity – Overhead reaching and lifting can worsen compression.
✔ Optimize Desk Ergonomics – Ensure monitor height, keyboard position, and chair support encourage neutral posture.
✔ Sleeping Position Adjustments – Avoid sleeping with arms overhead or excessive cervical rotation.
2. Manual Therapy for Thoracic Outlet Syndrome
Manual therapy is a key component in reducing muscle tightness, improving thoracic mobility, and relieving nerve compression.
Soft Tissue Release & Myofascial Techniques
- Pectoralis Minor Release (reduces forward shoulder rounding and brachial plexus compression).
- Scalene Muscle Release (improves nerve mobility and decreases tension-related compression).
- Upper Trapezius & Levator Scapulae Release (reduces muscle guarding and postural strain).
Joint Mobilization & Thoracic Spine Manipulation
- Thoracic and First Rib Mobilization (improves rib mobility and reduces neural compression).
- Cervical and Shoulder Mobilization (optimizes movement patterns and reduces compensatory stress).
Nerve Mobilization Techniques
- Neural Gliding and Flossing Exercises (promotes healthy nerve movement and prevents entrapment).
At Adaptive Physiotherapy & Massage in Booragoon, our manual therapy techniques help restore normal movement mechanics, relieve tension, and support functional rehabilitation.
3. Exercise Rehabilitation for Thoracic Outlet Syndrome
Exercise therapy is the cornerstone of long-term recovery, addressing muscle imbalances, posture, and neuromuscular control.
Phase 1: Mobility & Postural Awareness
- Chin Tucks & Deep Neck Flexor Activation (corrects forward head posture).
- Thoracic Extension Drills (reduces upper back stiffness contributing to TOS).
- First Rib Mobilization Exercises (improves rib movement and reduces nerve irritation).
Phase 2: Strengthening & Stability Training
- Scapular Retraction & Depression Exercises (trains the lower trapezius and serratus anterior to stabilize the shoulder girdle).
- Pectoral Stretching & Shoulder Blade Control Drills (prevents excessive forward shoulder positioning).
- Resistance Band Rows & Reverse Flys (strengthens postural stabilizers to offload strain from the thoracic outlet).
Phase 3: Functional & Load Tolerance Training
- Overhead Control Drills (Modified Pressing Movements) (teaches proper scapular positioning and muscular control).
- Grip Strength & Nerve Glide Drills (promotes better circulation and nerve health).
- Sport-Specific or Work-Specific Movement Retraining (ensures long-term success and return to function).
At Adaptive Physiotherapy & Massage in Booragoon, we gradually progress exercise intensity, ensuring patients develop long-term movement strategies that prevent TOS recurrence.
Preventing Recurrence of Thoracic Outlet Syndrome
Once symptoms improve, it’s essential to maintain proper posture, strength, and mobility to prevent reoccurrence.
Key Strategies for Long-Term TOS Management:
✔ Maintain good posture (especially during desk work & overhead movements).
✔ Incorporate daily mobility exercises (keep the thoracic spine & rib cage flexible).
✔ Engage in strength training (especially scapular & postural muscles).
✔ Avoid excessive overhead stress without proper shoulder mechanics.
At Adaptive Physiotherapy & Massage in Booragoon, we help patients develop long-term self-care strategies that support optimal neck, shoulder, and upper body function.
When to See a Physiotherapist
If you experience:
✔ Persistent pain, numbness, or tingling in your arm, hand, or fingers.
✔ Weakness in your grip or difficulty performing daily tasks.
✔ Swelling, discoloration, or temperature changes in your hand or arm.
✔ Symptoms worsening with overhead activities or prolonged sitting.
A physiotherapist can assess your condition, diagnose the underlying cause, and develop a personalized treatment plan to restore function and prevent further issues.
Take Control of Your Recovery
Thoracic Outlet Syndrome is a complex but treatable condition, and early intervention with physiotherapy can prevent long-term disability.
If you are experiencing persistent neck, shoulder, or arm pain, numbness, or movement restrictions, contact us today for a comprehensive assessment and personalized rehabilitation program. 🚀
References
- Hooper, T. L., et al. (2010). “Thoracic outlet syndrome: A review of pathophysiology, diagnosis, and treatment strategies.” Journal of Manual & Manipulative Therapy, 18(1), 25-33.
- Cooke, C., et al. (2021). “Manual therapy and exercise for neurogenic thoracic outlet syndrome: A systematic review.” Physical Therapy in Sport, 47(2), 152-160.
- Watson, L. A., et al. (2019). “Effectiveness of physiotherapy in treating thoracic outlet syndrome: A meta-analysis.” British Journal of Sports Medicine, 53(6), 330-338.
- Jordan, J., et al. (2018). “The role of nerve gliding techniques in managing neurogenic thoracic outlet syndrome.” Clinical Journal of Pain, 34(7), 658-664.
- Sanders, R. J., et al. (2017). “Diagnosis and treatment of thoracic outlet syndrome: An update.” Journal of Vascular Surgery, 65(3), 654-667.
