Todd Kuslikis

Todd Kuslikis

MMT, MPA
Knee Pain Specialist and Injury Prevention Expert

Thoracic Outlet Syndrome – Everything You Need To Know

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Some days, it seems like everything hurts.  After all, between aging and doing activities using muscles that are usually kicking back relaxing, there are many reasons this might temporarily be the case.

Sometimes, though, it can be more serious.  If you’ve ever noticed neck and shoulder pain in combination with numbness in your fingers, there’s a chance you have Thoracic Outlet Syndrome, or TOS.  

TOS affects your thoracic outlet – the space between your collarbone and first rib. While it’s usually caused by either trauma or repetitive injury, there are several factors that could contribute. 

In this post, we will go over what Thoracic Outlet Syndrome is and how it affects daily life as well as provide treatment options for those living with TOS pain.

 

Anatomy of the Thoracic Outlet

The thoracic outlet is the part of the neck where blood vessels and nerves pass through from the chest to the arms. It begins just above and behind the collarbone, extending down into the armpit area underneath the pec muscles.

Another way to pinpoint it is, if you’re looking at yourself in the mirror, putting your hand on your neck and turning your head to the right or left.  The muscles that pop out are your sternocleidomastoids.  The thoracic outlet is between each of those and your trapezius muscle on either side of your body.

 

Types of Thoracic Outlet Syndrome

TOS can be further categorized into three specific conditions: arterial, neurogenic, and venous.

 

Arterial Thoracic Outlet Syndrome

In Arterial TOS, the subclavian artery, located just below the collarbone, becomes compressed. This blocks, or closes, the blood vessel.  And as I’m sure you could guess, preventing the flow of blood is never good.

 

Neurogenic Thoracic Outlet Syndrome

Neurogenic Thoracic Outlet Syndrome is a condition that involves thoracic outlet nerves that branch from the vertebrae in your spine to your chest. These nerves pass over the first rib through a small channel on its underside, and into the chest. 

 

When added stress is placed on these nerve or spinal cord connections–for example, during heavy lifting—the pressure can lead to things like pain around the neck and shoulder with pain or tingling down the arm.  

 

It’s unpleasant, to say the least, but on the bright side, it’s a pretty clear sign that something is wrong and that you should get help.

Neurogenic is the most common of the three types.

 

Venous Thoracic Outlet Syndrome (TOS)

In this condition, the subclavian vein, which carries blood from the upper extremities back to the heart, gets squeezed between two bones.  The pressure on this important vessel can lead to all sorts of problems if not treated properly.  

 

Just to really drive this home, blocking blood from going to where it was designed to go is always bad.

 

Causes of Thoracic Outlet Syndrome

TOS can be triggered by either chronic or acute trauma to the thoracic outlet. Chronic trauma is repeated and involves a longer period of time exposed to a stressful event, like working in a physically demanding job for many years.  Acute trauma is a single event, like a car accident or a fall.

The most common causes include:

    • Heavy lifting
    • Accidents
    • Work related injuries (e.g., moving heavy objects)
    • Anatomical defects
    • Poor posture that causes nerve compression
    • Repetitive arm movements

Risk Factors: Who is affected by TOS?

TOS is a disorder that can affect men and women of any age, but some are more at-risk than others. Here are the two major factors which may contribute to the onset:

 

Sex:

Unfortunately, women are more likely to develop Thoracic Outlet Syndrome than men. For women, it can also be caused by pregnancy, which can sometimes just be exacerbating pre-existing thoracic outlet syndrome versus causing a new problem.

 

Age:

Thoracic Outlet Syndrome can occur at any age but seems to be most common in middle-aged adults aged 40-60.  Furthermore, it’s often related to injury or trauma that activates long term nerve compression or causes compression of the subclavian artery.  Remember, this is the artery just below the collarbones.

Don’t stress if you’re a woman in the age range listed!  While you might be in the group where TOS is most common, it doesn’t mean that it’s a common issue.  It just means that of the small number of people who develop it, they share these two characteristics with you.

 

Thoracic Outlet Syndrome Symptoms

There are many possible symptoms of Thoracic Outlet Syndrome, and they will depend on which of the three types you have. Some typical ones include:

    • Sleep disorders
    • Stress or depression
    • Pain in the neck, arm or shoulder
    • Numbness and tingling
    • Swelling
    • A feeling of heaviness in the arm

 

Thoracic Outlet Syndrome Test

So other than noticing symptoms, how can you tell if you have TOS?  The elevated arm stress test, also known as the Roos test, is a physical exercise that may be able to diagnose Thoracic Outlet Syndrome.  

 

How do you do it? 

 

It’s not too difficult and can be performed at home.  Check out the steps below:

    • Sit or stand with your arms out and bent 90°.  You should be in a “goalpost” position.
    • Open and close your hands slowly and repeatedly for three minutes.  Think about doing the chicken dance.
    •  If you are unable to complete the three minutes, or you have pain, heaviness, weakness, numbness, or tingling, you may have a problem with your thoracic outlet.  See your doctor for more comprehensive testing.

 

How Serious is TOS?

Paralysis |Feel Good LifeLet me be clear.  Thoracic Outlet Syndrome is not a life-threatening condition.  It can, however, produce some severe symptoms, such as paralysis, in some cases.

 

As mentioned, TOS has been shown to cause pain in the chest, arm, and shoulder region and is usually accompanied by numbness. It causes symptoms that can be very debilitating and painful and may also lead to depression or anxiety.

 

It may also contribute to difficulty sleeping due to discomfort associated with breathing and other symptoms.  In order to best get help alleviating your symptoms, you should be diagnosed and treated by a physician.

 

Do I Need Thoracic Outlet Syndrome Surgery?

When to use Knee Compression Sleeves ?

In short, maybe.  While Thoracic Outlet Syndrome is generally treated with both surgery and therapeutic exercises, it can also be successfully managed through exercises alone for those who have had a shorter duration of symptoms.

 

Treatment for TOS varies greatly based on the severity; some patients may need to have thoracic outlet syndrome surgery within days while others could wait years.

 

If the problem persists without treatment, TOS generally leads to more serious symptoms such as paralysis or difficulty breathing.  In other words, the sooner you recognize you have a problem, the more likely you are to be able to treat the symptoms with exercises alone. 

 

Never hesitate to make an appointment with your doctor.  Thoracic Outlet Syndrome is treatable as long as it’s caught early.

 

How to Stop TOS From Recurring

To manage TOS, you can perform daily exercises for the neck and shoulders which, when done on a regular basis, will strengthen the muscles in the area and relieve symptoms like chest tightness, pain or tingling. 

 

Stretches are another great option that targets various muscles in order to prevent future issues from developing. Spend a few minutes doing this every day, and practice good posture and lifting techniques, and you’ll likely avoid having to deal with everything we’ve been discussing.

 

Thoracic Outlet Syndrome Exercises

Ok.  So you can help relieve symptoms of TOS with exercise.  Anything specific? 

Your focus should be on exercises that target the muscles in your neck, back, and shoulders in order to strengthen and stretch them.  Try some of these:

 

Scapular Retraction:

This exercise is not only excellent for mitigating pain, but it will help with your posture. Good posture will make you appear taller and more confident, as an extra perk! 

 

Scapular Retraction | Feel Good Life

    • Start by sitting in a sturdy chair.
    • Sit up tall with good posture.  Your ears should be directly above your shoulders, and shoulders should be in line with your hips.
    • Draw your shoulder blades down and back. You’ll feel your chest stretch and open and your back muscles engage.
    • Hold 2 sec, and repeat for 2 sets of 10.

 

Row:

The row is a classic move for good reason.  It’s also great for posture.  You’re going to be walking like you’re on the red carpet soon!

    • Hold the ends of the resistance band, drawing your elbows back–keep them close to your body–while also pulling your shoulder blades down and back. You should feel this in your back.
    • Reach forward, decreasing the tension on the band as you return to the starting position.
    • Repeat for 3 sets of 10.

 

Lower Trap Rows:

This is a variation on the exercise above with more focus on the lower traps. It’s a little more challenging, and you may need to take a step closer to the door in order to have more slack with the resistance band to perform it.

    • Loop a resistance band around a door knob and close it.  Make sure the door is secure and won’t open on you.
    • Hold the ends of the resistance band, keeping your arms straight – don’t bend your elbows like in the last exercise –  while pulling your shoulder blades down and back. You should feel this in your back and triceps.
    • Repeat for 3 sets of 10.

 

 

TOS stretches

1. Chin Tucks

Chin tucks are a small move that leads to big results.
Why Postural Exercises are Better Than Passive Stretching for Relieving Neck Tension | Feel Good Life with Coach Todd

    • Sit or stand upright and look straight ahead with your ears directly over your shoulders. Think of a string pulling from the base of your spine, through the crown of your head, and finally to the ceiling.
    • Place a finger on your chin. Without moving the finger, pull the chin and head straight back — as if another string is pulling the back of your head to the wall behind you — until a good stretch is felt at the base of the head and top of the neck. Hold for 5 seconds if possible.
    • Bring the chin forward again to meet the finger where you left it.
    • Repeat for 2 sets of 10 reps.

 

2. Chest Stretch

Have you ever wanted to get a deep stretch in that hard-to-reach pec area?  This is the one for you:

    • Standing in a doorway, bend your elbows with your forearms pressed to the doorframe on either side.
    • Step forward with one foot until you feel a stretch in your chest.
    • Hold 30 sec and repeat for 3 sets.
    • Note: You can also perform this with one arm instead of two if you want to target one side of your chest.

 

3. Scalene Stretch

Many people never think about their scalene muscles, but they’re very important for moving your neck.  This stretch will show you exactly where they’re located: 

    • Place your hands over your chest to the left of your sternum.
    • Gently extend your head towards your right shoulder until you feel a gentle stretch.
    • Hold 30 sec and repeat on the other side.  Do 3 sets.

 

Thoracic Outlet Syndrome – Sleeping Position

What’s the best way to sleep when you’ve been diagnosed with Thoracic Outlet Syndrome? Sleeping on your back for an extended period of time can cause pain, as it compresses the thoracic outlet and sphincter. Sleeping on your side could potentially reduce pain. I’d suggest the latter.

 

Also, be careful about how you position your arms.  You’ll find that in certain positions, pain and tightness can occur. If at all possible, try avoiding having your arms above shoulder height for too long; this puts pressure on the thoracic sphincter and outlet area which can cause increased discomfort or numbness of fingers.

 

Remember, Thoracic Outlet Syndrome isn’t the end of the world, but it’s important to get it diagnosed early.  Time matters here.  Know the symptoms.  Be aware of what you’re feeling.  And always get your yearly checkup!

 

 

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