Physical Therapy for

Thoracic Outlet Syndrome (TOS)

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What is the Thoracic Outlet?

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.

How does it feel?

TOS symptoms can vary greatly but patients often experience a combination of the following:

  • Numbness/tingling in the arm or hand especially when the arm is by the side or overhead
  • Cold sensation or decreased sensation in the arm or hand
  • Pulsing sensation in the arm or hand
  • Weakness in the arm or hand
  • Symptoms can often mimic neck problems such as a pinched nerve or bulging disc which requires a very in-depth examination

Primary causes of TOS

Scalene muscles

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.

1st Rib

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.

Pectoralis minor

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

Anterior shoulder

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.


What We Do >>

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.

How We Do It >>

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.

Why We Do It >>

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.

Treatment Plan

We may use a combination of the following
techniques to help you get your life back:

  • Spinal manipulation/mobilization to decrease pain and improve spinal motion in the neck and mid-back
  • Soft tissue mobilization to reduce muscle guarding and tension in the neck muscles specifically the scalenes, pec minor, or surrounding muscles
  • Dry Needling to reduce muscular pain and increase the health of muscle tissue specifically in the neck and shoulder
  • Neuromuscular retraining to teach your body how to move in a better way
  • Mobility training to increase flexibility and range of motion in your neck and mid-back
  • Strength training increase your postural muscle strength as well as strength in the muscles along your shoulder blades
  • Endurance training to improve your postural muscle capacity for things like working or studying

What Should I Do Next?

Schedule an initial examination
Let us find the root cause of your pain
Create a custom treatment plan for you
Start living pain-free!

Eliminate Pain, Enjoy Your Life, B Your Best!

Want More Information?

Schedule a complimentary consultation
(407) 698-5558
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