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What is Throacic Outlet Syndrome

Updated: Aug 26, 2023

Thoracic outlet syndrome (TOS) is a condition that involves the compression or irritation of nerves, blood vessels, or both, as they pass through the thoracic outlet. The thoracic outlet is the narrow space between the collarbone (clavicle) and the first rib. This space contains important structures such as nerves, blood vessels, and muscles that connect the upper extremities (arms) to the rest of the body. TOS can occur when there is a narrowing or compression of this space, leading to symptoms that primarily affect the upper extremities. There are three main types of thoracic outlet syndrome:

Neurogenic Thoracic Outlet Syndrome (NTOS): This is the most common form of TOS and involves the compression of the brachial plexus, a network of nerves that control the muscles and sensation of the arm and hand. Symptoms may include pain, numbness, tingling, or weakness in the arm, shoulder, or hand. NTOS is often associated with poor posture, muscle imbalances, or anatomical variations.

Vascular Thoracic Outlet Syndrome (VTOS): In VTOS, blood vessels, particularly the subclavian artery or vein, are compressed or narrowed. This can lead to symptoms such as pain, swelling, and discoloration of the arm, especially after activity. Blood clots and circulation issues may also occur in severe cases.

Nonspecific or Disputed Thoracic Outlet Syndrome: This category includes cases where symptoms are present, but the exact cause of compression or irritation is unclear or disputed. It can be challenging to diagnose and treat this type of TOS.

Common risk factors for developing thoracic outlet syndrome include:

  • Poor posture, especially with rounded shoulders and a forward head position.

  • Repetitive overhead arm movements.

  • Trauma, such as whiplash injuries or fractures.

  • Anatomical abnormalities, such as cervical ribs (extra ribs near the neck).

  • Muscle imbalances or tightness in the neck, shoulder, or chest muscles.

  • Obesity.

Diagnosis of TOS typically involves a thorough medical history, physical examination, and sometimes imaging studies like X-rays, MRI, or nerve conduction studies to assess nerve function. Treatment for thoracic outlet syndrome may include:

  • Osteopathy: Stretching and strengthening exercises to improve posture, and muscle balance, and alleviate compression.

  • Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain-relieving medications.

  • Lifestyle modifications: Ergonomic adjustments, postural training, and avoiding activities that worsen symptoms.

  • Nerve gliding exercises: Techniques to promote nerve mobility and reduce irritation.

  • Vascular intervention: Surgical procedures to address blood vessel compression or repair.

  • In some cases, surgery may be necessary to relieve severe compression or correct anatomical abnormalities.

Ann Shivas brings over 9 years of invaluable experience in the field of Osteopathy. Her journey has taken her across the globe, where she has had the privilege of working closely with professional athletes, aiding them in their pursuit of optimal health and performance. Ann's passion for Osteopathy extends beyond the limelight, as she is dedicated to sharing her extensive knowledge with her local community in Comox Valley, Courtney, and Cumberland. Through her work, Ann aims to raise awareness about the remarkable benefits of Osteopathy and its potential to transform lives. For those seeking to experience the advantages firsthand, appointments can be conveniently booked online via this link: Book Now.


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