When the major nerves and blood arteries in the area between the neck and shoulder are compressed, this is referred to as thoracoscopy outlet syndrome (TOS).
More than 90 percent of cases include compression and irritation of the nerves as they pass through the thoracic outlet, according to the American Chiropractic Association.
A less common occurrence involves the involvement of the blood vessel.
Common thoracic outlet syndrome symptoms include neck and upper back discomfort as well as pain in the shoulder muscles, arm, and hand.
Chronic pain, numbness, tingling, and weakening of the arm, hand, and fingers with soft tissue and tight muscle are other common side effects of this condition.
When performing overhead positions or activities such as throwing a baseball, the symptoms are exacerbated.
The symptoms of TOS are exacerbated even further by repeated occupations such as extended typing that may damaged the subclavian artery and subclavian vein.
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Table of Contents
What exercises are recommended for treating thoracic outlet syndrome (TOS)?
Lie down and side-bend your neck away from your affected side, while turning slightly towards your affected side.
On order to increase the stretch in the side of the neck, finish by performing a mild chin tuck.
Keep your body in this position for 30 seconds.
If you are experiencing symptoms when stretching, begin with shorter hold times and work your way up to 30 seconds or longer.
What is thoracic outlet syndrome?
When there is compression, damage, or irritation of the nerves and/or blood vessel (arteries and veins) in the lower neck and upper chest area, a condition known as thoracic outlet syndrome (TOS) occurs. A collection of nerves and blood arteries located between your lower neck and upper chest is referred to as thoracic outlet syndrome, which is called after the place (the thoracic outlet) where it is found.
Who is afflicted with thoracic outlet syndrome?
It is a condition that affects people of all ages and genders. Baseball, swimming, volleyball, and other sports that demand repetitive motions of the arm and shoulder, as well as other sports, are among those that are most prone to the illness.
Neurogenic TOS is the most frequent form of the condition (neurogenic TOS accounts for 95 percent of all cases of TOS), and it primarily affects middle-aged women.
Recent research has revealed that, in general, TOS is more common in women than in males, and that it is particularly prevalent in those with poor muscular development, bad posture, or a combination of both.
The Thoracic Outlet: Anatomy and Function
The thoracic outlet is composed of three components that reach from the neck to the front of the shoulder.
The inter scalene triangle is the first of these components.
In the neck, nerves emerge through the space between the two scalene muscles.
Abnormalities in these muscles might cause nerve compression or discomfort if they are not properly developed.
The costoclavicular space is the name given to the second component of the thoracic outlet. In this case, it refers to the region that lies between the collar bone and the first rib.
Asymmetry of the first rib or the presence of an extra rib, which is referred to as the “cervical rib,” can cause irritation of the nerves or blood vessel.
The area between the pectoralis minor muscle and the rib cage constitutes the third component of the thoracic outlet system.
Specific Characteristics
Patients with thoracic outlet syndrome experience a wide range of signs and tos symptoms, which vary depending on where the nerve and/or vascular has been affected.
In extreme cases, symptoms can range from minor discomfort and sensory abnormalities to life-threatening consequences that can result in limb loss.
In most cases, patients suffering from thoracic outlet syndrome experience pain anywhere between the neck and occipital region or into the chest, shoulder, and upper extremities.
They may also experience paresthesia in the upper extremity if the condition is severe.
In addition, the patient may complain of changed or absent sensations, weakness, weariness, and a sensation of heaviness in the arm and hand, among other things.
In addition, the skin may be blotchy or discolored. It is also possible to observe a difference in temperature.
When the arm is abducted overhead and externally rotated as the head is turned to the same or opposite side, the signs and symptoms are often severe.
The symptoms may worsen if you perform activities such as overhead throwing, serving a tennis ball, painting the ceilings of your home, driving, or typing.
There is pain in the side of the neck when the upper plexus (C5,6,7) is affected, and this discomfort may spread to the ear and face when the upper plexus is involved.
Pain frequently extends from the ear, usually posteriorly to the rhomboids and anteriorly to the clavicle and pectoralis major muscle groups.
It is possible that the discomfort will spread laterally down the radial nerve area.
When the upper plexus or brachial plexus is implicated, it is fairly uncommon to experience headaches.
Lower plexus (C8, T1) involvement is characterized by a range of symptoms that begin in the anterior or posterior shoulder region and spread down the ulnar side of the forearm into the hand, particularly the ring and small fingers.
Is thoracic outlet syndrome serious?
Although many cases of thoracic outlet syndrome (TOS) can’t be prevented, the ailment is treatable.
If left untreated, TOS can produce complications, such as:
- Permanent arm swelling and pain (particularly in those with venous TOS)
- Ischemic ulcer of the fingers (open sore caused by decreased blood flow) (open sore caused by reduced blood flow)
- Gangrene (the death of body tissue, often induced by a decrease of blood supply) (the death of body tissue, often caused by a loss of blood flow)
- Blood clot
- Pulmonary embolism (obstruction in a blood vessel owing to a blood clot)
- Neurogenic consequences, such as permanent nerve damage
Thoracic Outlet Syndrome Is Treated In A Variety Of Ways.
In order to treat TOS, the patient must first refrain from engaging in any aggravating activities, including overhead sports (baseball pitching) and repetitive duties (such as keyboarding).
The next step is to get the patient referred to a physical therapist.
Physical treatment for thoracic outlet syndrome focuses on the three principal compression sites in the neck and back.
The scalene muscles, first rib, and pectoral muscles are the primary targets of manual treatment techniques and stretching exercises.
To promote the health of inflamed nerves, nerve gliding activities are advised.
Exercises for postural correction are also an important part of the program.
The next step is to prescribe pain-free strengthening exercises for the shoulder and upper back muscles that are tailored to the patient's specific needs and goals, if needed.
Exercises for Neurogenic Thoracic Outlet Syndrome
Here are some manual therapy or exercises that may help treat your thoracic outlet syndrome instead of other physical therapy.
1. Stretching the Scalene Muscles
Stretching the scalene muscles helps to relieve irritation of the nerves and blood vessels located within the inter scalene triangle, which is formed by the scalene muscles.
Begin sitting with a strap or belt wrapped over the shoulder that is being impacted.
Pulling down on the strap will bring it closer to your opposite hip.
Lie down and side-bend your neck away from your affected side, while turning slightly towards your affected side.
On order to increase the stretch in the side of the neck, finish by performing a mild chin tuck.
If you are experiencing symptoms when stretching, begin with shorter hold times and work your way up to 30 seconds or longer.
2. Self-Mobilization of the First Rib
It is possible to reduce irritation of the nerves and blood vessels located just below the first rib by increasing the mobility and position of the rib.
Begin sitting with a strap or belt wrapped over the shoulder that is being impacted.
Pulling down on the strap will bring it closer to your opposite hip.
Side-bend the neck toward the side that is affected.
Take a look below the armpit.
The scalene muscles are relaxed in this position, allowing the forces to be directed to the rib.
Ten calm and deep breaths should be taken while maintaining pressure with the strap in order to mobilize the rib.
3. Stretching the Pec Minor Muscles
Improving the length and mobility of the pectoralis minor will help to relieve irritation of the nerves that run beneath this muscle.
Begin by lying on your back with a foam roll under your hips and spine.
Allow the arms to fall down towards the floor with the elbows bent to the side.
Exhale fully and hold this position for 30 seconds to allow your muscles to rest.
It is critical for your spine to remain in contact with the foam roll during this exercise.
If you are experiencing symptoms when stretching, begin with shorter hold times and work your way up to 30 seconds or longer.
4. Strengthening of the Trapezius Muscle
Lay face down on a table or bench with one arm draped over the side of the table or bench to strengthen the lower trapezius muscle.
Make sure your neck is in a comfortable neutral position, resting on your other forearm, throughout the exercise.
Lift your arm toward the sky at a 45-degree angle from your head with your thumb up, arm straight, elbow slightly bent, and arm straight again (the 10:00 and 2:00 positions of a clock).
This position places the lower trapezius muscle fibers in a line with the upper trapezius muscle fibers.
Take care not to elevate your arm to the point where you shrug your entire shoulder.
Instead, think about tilting the shoulder blade backward as you raise the arm as you raise the arm.
Before returning to the starting position, take a moment to pause at the peak of the exercise.
The middle trapezius is trained in a similar manner as the upper trapezius.
To target your middle trapezius, perform the action with your arm straight out to the side and your arm straight up.
On a clock, this corresponds to the 9:00 and 3:00 o'clock positions respectively.
Strengthening both the middle and lower trapezius will help to position the shoulder blade in such a way that nerve irritation in the thoracic outlet is reduced.
What is the procedure for diagnosing thoracic outlet syndrome?
The most important step in TOS is to make an accurate diagnosis of the situation.
The following types of doctors can treat this condition: vascular surgeons, chest (thoracic) surgeons, and vascular medicine specialists.
Your doctor will conduct a thorough physical examination and evaluate the findings of any previous diagnostic tests in order to determine the nature of your ailment.
Sometimes, a comprehensive evaluation by a qualified neurologist is necessary to rule out cervical spine disease or other neurological diseases that may be imitating or causing your symptoms.
In addition to these tests, the following are used to diagnose thoracic outlet syndrome before surgery:
- Studies on the conduction of nerve impulses (to evaluate the function of the motor and sensory nerves)
- Investigations into the vasculature (of the arteries or veins)
- An X-ray of the chest is performed to rule out cervical rib abnormalities.
- Radiology studies of the cervical spine to rule out the presence of a cervical rib (extra rib) or cervical (neck) spine abnormalities.
- The use of a chest CT scan or magnetic resonance imaging (MRI) of the spine to rule out cervical spine impingement (pressure), which might mimic neurogenic thoracic outlet syndrome, are recommended.
- MRA (magnetic resonance angiography) is a technique used to see blood arteries.
- Angiogram/venogram are two terms that are used to describe the same thing (X-ray that uses dye to look at blood flow)
- Tests of the blood
Final Thoughts
Thoracic outlet syndrome can be quite painful and have a significant influence on your overall quality of life and may result to surgical intervention with vascular surgery that may suffer into surgical decompression.
Not everyone who has TOS has to suffer as a result of it.
There are also other syndrome related to the tos syndrome.
Like the carpal tunnel syndrome, the venous thoracic outlet syndrome, the arterial thoracic outlet syndrome and the vascular thoracic outlet syndrome
Only a small sample of the types of workouts that can be beneficial is represented by these four exercises especially if you have a poor posture.
Meet with your physical therapist and begin the process of recuperation.
Your physical therapist will evaluate your injuries on a regular basis and progress your exercise program in accordance with your goals.
Ultimately, the goal is to reduce discomfort and restore your quality of life to you as quickly as possible.
Frequently Asked Questions (FAQ)
Is it possible for thoracic outlet syndrome to improve on its own?
No. For persons who have moderate TOS, a change in their way of life may be sufficient to alleviate their symptoms.
More significant TOS, on the other hand, should be addressed by a doctor as quickly as possible.
Ice can be used to tired or injured muscles to help reduce the swelling and inflammation.
Heat can also help to relieve sore muscles by increasing circulation to the area where the pain is occurring.
While the entire arm is often in agony, applying cold or heat to the thoracic region can provide some temporary relief (collar bone, armpit, or shoulder blades).
Thoracic Outlet Syndrome is a condition that is diagnosed mostly on the basis of symptoms.
When the body is lying down, the pressure on the nerves is relieved, which is why nocturnal experiences are so widespread in the population.
As the pressure on the nerves is relieved, the sensation of “pins and needles” is experienced by the patient.
