What is Thoracic Outlet Syndrome?

It is easy to mistake the symptoms of Thoracic Outlet Syndrome (TOS) for other things.

TOS is a complex issue that can take time to diagnose. This is because the symptoms can be seemingly diffuse and difficult to pinpoint.

Thoraoc Outlet Syndrome is a condition affecting the upper extremities. There are a number of arm symptoms.

TOS is caused by the compression of structures in what is called the neurovascular bundle. The name is just what you think. This bundle contains nerves and vasculature (veins and arteries) that move together. They are responsible for sending messages to and from the brain and spinal cord, and blood to and from the heart.

The area of compression of these structures is in the thoracic outlet. The thoracic outlet is made of the area above the first rib, at the side of the neck, between the collarbone and rib and between the top ribs and the muscle of the pectorals minor.

Some Facts:

  • TOS is more common in women
  • Structural anomalies, can contribute to the development of TOS. This includes having an extra rib, or differences where some neck muscles attach.

Types of TOS:

  1. Vascular – Is less common. It affects the blood supply in the thoracic region.
  2. Neurological – Is broken into true neurological and symptomatic subgroups.
  3. True Neurological – is called true, because it can be confirmed using imaging.
  4. Symptomatic TOS – is the presence of symptoms without finding anything in the imaging. This is the most common type of TOS by far. Because of this many people are lead on a “wild goose chase” of tests and imaging, even before being sent to Physio, Massage, or Acupuncture.

Signs and Symptoms of Thoracic Outlet Syndrome:

The signs and symptoms can vary between people. They can fluctuate and range from an annoyance to very painful.

  • Pain – in the neck, shoulder, arm or chest.
  • Tingling and Numbness – in the arm and / or hand
  • Swelling, coolness, visible discolouration of the arm / hand are more rare symptoms.
  • Tension or thickening in the side neck muscles (called the scalenes).
Man at desk showing tennis elbow being treated by an Oakville Physio

Yes we Treat TOS at our North Oakville Clinic:

We benefit form working in a multidisciplinary clinic where we can work together to help the same person. We are able to collaborate and bounce ideas off of one another (with a patients permission of course).

Our Oakville Physiotherapists, Massage Therapists, and Acupuncturist are able to work within their scope of practice. This allows us to help a person with TOS manage their symptoms as well as improve.

TOS is generally treated conservatively. This means through the use of medications prescribed by your physician, exercises, and some hands-on treatment. Most cases do improve over time with consistent treatment including a home program.

Exercises for TOS focus on postures, nerve mobilizations, muscle strength and control of the shoulder blade muscles. Physiotherapists may provide some stretching, soft tissue techniques of tight muscles and mobilizations of the ribs and neck. Your Massage Therapist will offer gentle stretching, and massage of areas of tension. Your acupuncturist may provide acupuncture along the course of the nerves affected. This may help decrease the numbness and tingling, relax muscles, help with pain and help with inflammation.

photo showing Massage Therapy in Oakville

If you have been having pain, tingling, and numbness in the arm, we are here to help.

Contact our North Oakville Clinic. We service our local areas of Milton, Oakville, and Burlington within clinic and our Physiotherapists are able to “see” and treat patients virtually all over Ontario.