Thoracic Outlet Syndrome (TOS) is a complex condition that requires a thorough examination to determine the root cause of the issue.
The thoracic outlet refers to the small space between the first rib and your collar bone. Within this space, important blood vessels and nerves from your neck course through in order to travel down into your arm. There is also a group of muscles called your scalenes that are often affected because they lie over this group of nerves and vessels.
TOS symptoms can vary greatly but patients often experience a combination of the following:
There are 3 scalene muscles that extend from the side of our neck into the 1st rib and these muscles can become tight and restricted causing compression of the vessels and nerves that extend from our neck down into our arm and hand.
The first rib sits at the top of our ribcage and has important attachments to key muscles including the scalenes. We often see that holding your breath will increase symptoms down the arm when the 1st rib is involved.
The “pec minor” sits underneath the large “pec major” muscle. It is a small muscle that has important vessels and nerves coursing beneath it. If this muscle is restricted or spasmed, it can cause TOS symptoms into the arm or hand
This seems unlikely but the front of your shoulder can cause TOS symptoms into the arm or hand. This is why careful examination is required to properly diagnose TOS.
We determine if you have TOS ruling out a pinched neck nerve, shoulder strain, shoulder impingement, and over pathologies that could mimic similar symptoms. TOS requires very special testing and examination to be treated correctly to provide fast relief and long-term improvement. You may recall a famous case of thoracic outlet syndrome with Orlando Magic player, Markelle Fultz.
TOS treatment incorporates soft tissue work to specific tissues affecting the nerves and vessels that go down your arm. These muscles can include the scalenes, pectoralis minor, pectoralis major, anterior deltoid and even the biceps tendon. We also incorporate hands-on mobilizations of the neck, shoulder, thoracic spine and ribs. Then, we focus on specific activity modifications and exercises to reduce irritation of the nerves and vessels around these muscles, bones, and joints. We typically see significant symptom improvement within just a few treatment sessions when TOS is correctly diagnosed.
Recent research has actually shown that physical therapy is a better option than surgery, pain medication and injections. We can help you avoid unnecessary invasive procedures and tests that cost a fortune with limited effectiveness.