Are you not able to continue your cherished hobbies or everyday activities because of sharp pain in your neck when you move? With our expert doctors’ help, you can get to the root of your symptoms and get back to doing what you love quicker and easier.
Thoracic Outlet Syndrome (TOS) is a potentially painful and disabling condition of the upper extremity. It results from the compression of structures in the thoracic outlet, a space just above the first rib, and behind the clavicle (collar bone). Due to the range of signs and symptoms that can lead to a diagnosis of TOS, the incidence rates of the condition currently are unknown. Physical therapists work with individuals who have TOS to ease their symptoms and restore their upper-body function.
What are common causes of Thoracic Outlet Syndrome?
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Where does it hurt?
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What are common symptoms of Thoracic Outlet Syndrome?
Because TOS generally is classified based upon the type of structures compressed, the symptoms experienced may vary. However, more than 90% of TOS cases are thought to be neurogenic (nerve compression) in nature (categories 3 and 4 below).
Arterial TOS
Pain in the hand; rarely in shoulder or neck
Coldness or cold intolerance
Numbness and tingling
Venous TOS
Pain in the arm
Swelling in the arm
Change in arm coloration (appears bluish)
Feeling of heaviness in the arm
Numbness and tingling in fingers and hands
True Neurogenic TOS
Pain, numbness, and tingling in the hand, arm, shoulder, and often the neck
Headaches
Numbness and tingling of the arm, often waking the individual up at night
Hand clumsiness
Intolerance to cold
Hand coldness and color changes
Disputed Neurogenic TOS
Pain, numbness and tingling in the hand, arm, shoulder and often the neck
Headaches
Numbness and tingling of the arm, often waking the individual up at night
Hand clumsiness
Intolerance to cold
Hand coldness and color changes
Symptoms greater at night vs day
Tests may come back normal (hence, the term “disputed”).
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“I came to Pursuit Therapy with neck and shoulder pain tightness […] immediately experienced results after my first session. I am not only pain free and have full range of motion, I also have the knowledge to prevent this from happening again. I wouldn’t think twice about recommending Pursuit Therapy!”
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What outcome can you expect from treatment?
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How is it diagnosed?
Diagnosis of TOS begins with a thorough health history and clinical examination.
Your physical therapist will likely check for color changes in the affected area, and gently attempt to provoke symptoms by moving the affected limb in different directions.
You also may be referred for diagnostic testing, such as a Doppler ultrasound, which can confirm arterial and venous TOS, or nerve conduction velocity testing to help confirm a true neurogenic TOS.
Your physical therapist may be the first to recognize an onset of TOS, because of its effects on your physical function. Your physical therapist may ask you:
When did you begin experiencing these symptoms, and when are they the worst?
Have you noticed any change in your symptoms when the temperature changes?
Have you noticed any significant changes in your ability to perform physical tasks that require hand movements?
Have you noticed any changes in the appearance of your arm or hand?
In addition, your physical therapist will rule out other conditions, which may mimic this disorder. Your therapist may ask you to fill out a questionnaire in order to better understand your physical state, and to screen for the presence of other conditions.
Once you have received a diagnosis of TOS, your physical therapist will work with you to develop a treatment plan to help ease the discomfort, and improve your ability to perform daily activities. Most research on this condition recommends a treatment plan that involves physical therapy to help ease your symptoms and improve function.
Physical therapy treatments may include:
Manual Therapy. Manual (hands-on) therapy may be applied to manipulate or mobilize the nerves of the arm to help reduce symptoms, such as pain and numbness/tingling. Your physical therapist also may attempt to gently mobilize your first rib and/or collar bone.
Movement and Strengthening Exercises. Your physical therapist will teach you muscle-strengthening exercises to improve movement and strength in the affected area.
Education. Your physical therapist will teach you strategies that can help minimize your symptoms while performing your daily functional activities.
Activity modification and postural strategies: Your physical therapist will teach you positions and strategies to place less stress on the structures involved with TOS.
“After at least three years of doctor-hopping […] looking for someone to alleviate my constant dizziness and neck pain, I finally found Dr. Miller. I have more energy and less pain, and have halved my dependence on painkillers. He shouldn’t be the last stop on your road to recovery, he should be the first.”
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How much does it cost?
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How long are sessions?
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Is there anything that I can do at home to help with Thoracic Outlet Syndrome?
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While some cases of TOS cannot be prevented, such as those due to anatomical variations, congenital conditions, trauma, or space-occupying lesions, others may be avoidable. Understanding risk factors that could make you more likely to develop this condition is the first step in prevention.
Your physical therapist will work with you to develop strategies to help you better understand and manage your risk factors and symptoms. As with many conditions, education is key. Understanding strategies, such as methods of reducing symptoms while performing activities, can help you live a full and functional life after the onset of TOS.
What are next steps?
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Call our expert team.
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Charles DeNave
Lisa Bywater
