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Thoracic Outlet Syndrome: AKA T.O.S.

By Bernard Fryer, Physical Therapist Assistant

Thoracic Outlet Syndrome (T.O.S.) is a syndrome that involves compression at the superior Thoracic outlet.  With this syndrome excess pressure is placed upon the nerves, arteries, and veins that pass between the anterior and middle scalene muscles of the neck.  It can affect one or more of the nerves and  the blood supply as it passes between the chest and upper extremity.  T.O.S. may be due to various reasons.  Some are due to posture, resulting in abnormal compression from the clavicle and shoulder girdle, especially with arm movement.  There are also static causes such as enlargement or spasm of the muscles surrounding the veins, arteries or the brachial plexus (nerves).  Another cause could be fixation of a first rib or cervical rib.

CLASSIFICATION 3 Types: Neurogenic involving compression of the components of the brachial plexus nerves. Arterial caused by compression of the subclavian artery. Venous due to compression of the subclavian vein.

SYMPTOMS: T.O.S. affects mainly the upper limbs with signs and symptoms manifesting in the arms and hands. A symptom may be pain always present that’s sharp, burning or aching. Pain may also be located in the side of the neck, the pectoral region just below the clavicle and into the arm pit.

TREATMENT: Most patients respond to conservative measures consisting of medications, rest, Physical Therapy and Chiropractic treatments. The goal of treatment is to relieve compression in the Thoracic cavity, reduce blood vessel and nerve impingement, and realign the bones, muscles, ligaments and/or tendons that are causing the problem. Invasive treatments have included cortisone and botox injections.

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