Thoracic Outlet Syndrome
Do you know what is Thoracic Outlet?
It is an area in your neck between your collar bone and first rib and is formed anteriorly by Anterior Scalene muscle, posteriorly by Middle Scalene muscle and by first rib inferiorly. So, it is basically a group of condition that results from compression of neurovascular structures at thoracic outlet. Thoracic outlet syndrome is subdivided into neurogenic, arterial and venous based on its etiology.[1] Neurogenic TOS occurs due to compression of Brachial Plexus (network of nerves in shoulder which transmits signals to your upper extremities), whereas arterial and venous TOS occurs due to entrapment of subclavian or axillary artery and vein respectively.[2] Vascular TOS commonly affects males in 2nd and 3rd decade of their life whereas females are more prone for development of neurogenic TOS between 20-40 years of age.[3]
Factors that make you more susceptible for development of TOS
If you are highly engaged in sports such as swimming, baseball which requires repetitive overhead activities, then you are at higher risk for development of TOS. Additionally, neck trauma, adaptive muscle shortening leading to chronic poor posture, fracture of collar bone, abnormal origin or insertion of muscle, presence of first cervical rib since birth could also be the contributory factors.
Common Symptoms that You Might Experience [4]
1. Symptoms suggesting that you are suffering from Neurogenic TOS:
- Feeling of heaviness in overhead activities
- Pins and Needle sensation in whole arm or just in fingers
- Continous neck pain
- Trapezius pain
2. What if you have Venous TOS:
- Swelling which makes your affected arm looks larger than the other one
- Heaviness in arms
- Cyanosis (bluish discoloration of your arm)
3. How Arterial TOS looks:
- Coldness or cold intolerance
- Pallor
- Pulselessness
- Weakness
- Pain
How Physical Therapy Can Help You
Physical Therapy plays vital role in effective management of your TOS. Physical therapist will evaluate your posture, muscle imbalances, range of available motion, muscle strength as well as neurological examination and certain special tests like Adson Test, Upper Limb Tension Test. Then TOS gets treated based on scientific evidence based approaches:[5]
Effective reduction of symptoms in case of highly irritable TOS is possible with external support which includes use of Axillary Sling, Kinesio Tape or Towel roll to maintain shoulder blade (scapula) in its appropriate position.
Altered Breathing technique leads to hypertrophy of Sternocleidomastoid, Scalene and Trapezius muscle which increases symptoms of TOS and hence Diaphragmatic Breathing serves great purpose in maintaining proper breathing pattern. Postural imbalance resulted from shortening of specific muscles can be corrected by selective stretching of Pectoralis Major, Upper Trapezius and Sternocleidomastoid muscle. In addition to this, Posterior Glenohumeral joint mobilization helps in improving overhead activities in athletes. Mobilization of Thoracic Spine helps in reducing thoracic Kyphosis (Hunch back) and hence improves posture. Moreover, Scapular control exercises which are performed in with various positions of shoulder blade mainly targets Serratus Anterior, Rhomboids, Infraspinatus, Teres Minor and Subscapularis muscle. However, during initial periods isometric exercises should only be done and strengthening should be done in later stages.
Many individuals have successfully managed their Thoracic Outlet Syndrome through focused and well-planned physical therapy treatments with us, we also provide detailed guide on home exercises and posture tips that help alleviate TOS symptoms.
References:
1. Li, N., Dierks, G., Vervaeke, H. E., Jumonville, A., Kaye, A. D., Myrcik, D., … & Urits, I. (2021). Thoracic outlet syndrome: a narrative review. Journal of clinical medicine, 10(5), 962.
2. Panther, E. J., Reintgen, C. D., Cueto, R. J., Hao, K. A., Chim, H., & King, J. J. (2022). Thoracic outlet syndrome: a review. Journal of shoulder and elbow surgery, 31(11), e545-e561
3. Jones, M. R., Prabhakar, A., Viswanath, O., Urits, I., Green, J. B., Kendrick, J. B., … & Kaye, A. D. (2019). Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment. Pain and therapy, 8, 5-18.
4. Hock, G., Johnson, A., Barber, P., & Papa, C. (2022). Current Clinical Concepts: Rehabilitation of Thoracic Outlet Syndrome. Journal of athletic training.
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