Thoracic Outlet Syndrome

Thoracic outlet Syndrome (TOS) is a group of disorders caused by compression of nerves and blood vessels as they travel through thoracic outlet-the narrow space between the collar bone and first rib. There are three main types of thoracic outlet syndrome - Neurogenic, venous and arterial . Neurogenic TOS is most common type and typically shows good improvement with physiotherapy. It involves compression of brachial plexus nerves.

Common symptoms of neurogenic TOS is numbness/ tingling in the arm, hand or fingers, neck, shoulder or arm pain along with muscle weakness and wasting in chronic cases . Symptoms often worse with overhead activity such as brushing hair.Cause and risk factors for TOS include poor posture, repetitive overhead activities and are commonly seen in individuals such as athletes and hair dressers. Other contributing factors include muscle tightness , cervical rib or first rib elevation, trauma such as whiplash and prolonged occupational stress.

Diagnosis is mainly clinical, based on thorough physical examination, ruling out other causes and sometimes supported by imaging such as nerve conduction studies. First line of treatment with neurogenic TOS is physiotherapy.

Physiotherapy treatment includes postural correction, stretching tight muscles, strengthening weak muscles (scapular stabilizers) , neural glides and breathing re-training . Treatment also includes daily activity modification, ergonomic changes and using techniques for pain management.The second line of treatment is injections and third option is surgical interventions for a failed conservative care for more than 6 months. Starting treatment early leads to better outcomes.Early physiotherapy can prevent long term nerve damage and significantly enhance your quality of life.

If you suspect you may have neurogenic TOS, book an assessment with a physiotherapist at Dalton physiotherapy and start your recovery journey today at Dalton Physiotherapy. You can book online at www.daltonphysio.ie or call us on 01-9081101