Thoracic Outlet Syndrome

Thoracic Outlet Syndrome

Article by J.Miller, Z.Russell

What is Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome is a complex condition in which blood vessels and/or nerves are entrapped or compressed as they exit the thorax. Thoracic Outlet Syndrome is caused by a compression of the brachial plexus or subclavian vessels as they exit the neck into the shoulder region and pass under the first rib.

Anatomy of the Thoracic Outlet

The structures most commonly compromised in Thoracic Outlet Syndrome are:

  • subclavian artery
  • subclavian vein
  • lower roots of the brachial plexus (bundle of nerves supplying the upper body and arms)

These structures may become compressed in 3 areas:

  • between the anterior and middle scalene muscles of the neck
  • between the collarbone and first rib
  • beneath the coracoid process of the shoulder blade

Types of Thoracic Outlet Syndrome

There are 2 main classifications of Thoracic Outlet Syndrome: Vascular & Neurological

Vascular Thoracic Outlet Syndrome

  • 2% of cases
  • Compression of the blood vessels exiting the thorax (subclavian artery or vein)

Neurological Thoracic Outlet Syndrome

  • 98% of cases
1. True Neurological Thoracic Outlet Syndrome:
  • Compression of nerves exiting thorax due to bony or soft tissue anomaly.
2. Symptomatic Thoracic Outlet Syndrome:
  • Intermittent compression of nerves and blood vessels due to repetitive postural, occupational or sporting forces (Watson et al., 2009)

Thoracic Outlet Syndrome Symptoms

Thoracic Outlet Syndrome is characterised by:

  • Pain, altered sensation and weakness of the upper limb.
  • Pain or discomfort is often felt above or below the collarbone and may radiate down the arm.
  • Altered sensation and temperature in the arm and hand is also associated with this condition.
  • Symptoms are generally aggravated or exacerbated by lifting your arm or turning your head or neck (Lindgren & Oksala, 1995).

Symptoms vary and are often difficult to differentiate from other shoulder aetiologies such as rotator cuff pathology or cervical radiculopathy (pinched nerve).

Vascular Thoracic Outlet Syndrome

  • Pins & needles, numbness in arm and hand
  • Decreased or absent arterial pulse
  • Swelling, coldness, colour change in arm and hand
  • Feeling of stiffness, heaviness fatigue in arm (Watson et al., 2009)

Neurological Thoracic Outlet Syndrome

  • Pain in neck, collar bone region, chest, upper back, shoulder, arm, hand
  • Pins & needles, numbness in fingers
  • Weakness of arm and hand
  • Loss of dexterity/coordination in hand
  • Muscle spasms in arm/hand
  • Feeling of stiffness, heaviness fatigue in arm
  • Pain at rest and night pain
  • Less commonly dizziness, headaches, vertigo (Watson et al., 2009)

Risk Factors for Thoracic Outlet Syndrome

  • Bony abnormalities, eg. abnormal first rib, cervical rib
  • Trauma
  • Poor posture
  • Jobs or sporting activities involving repetitive overhead movements
  • Weight gain

Common Thoracic Outlet Findings

Symptoms may increase with overhead ranges of motion on examination. You may also have a positive: Costoclavicular manouever, Roo’s test or Adson’s test.

If you suspect thoracic outlet syndrome, you may consider cervical spine X-rays to evaluate for the presence of a cervical rib, or prominent C7 transverse process that may be contributing to the symptoms. Additional tests (e.g., MRI, EMG) can be used to rule out other causes.

Physiotherapy Treatment of Thoracic Outlet Syndrome

  • Postural advice and education
  • Ergonomic assessment and intervention
  • Rest from aggravating activities
  • Correction of ‘dropped shoulder’ position (Watson et al., 2010)
  • Strengthening of shoulder blade stabilising muscles
  • Mobilisation of thoracic spine and first rib
  • Massage of neck, chest and upper back muscles
  • Neural gliding exercises

Surgery should only be considered if conservative treatment fails (MacKinnon & Novak, 2002)

For more specific information, please seek the advice of your physiotherapist.

Thoracic Outlet Syndrome Treatment Options

Thoracic outlet treatment will vary significantly depending on the structure causing your symptoms. Please consult your doctor or physiotherapist for specific thoracic outlet syndrome treatment.

Thoracic Outlet FAQs

What is Physiotherapy Treatment?

Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice.  Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.

There is a multitude of different physiotherapy treatment approaches.

Acute & Sub-Acute Injury Management

Hands-On Physiotherapy Techniques

physiotherapy treatment

Your physiotherapist's training includes hands-on physiotherapy techniques such as:

Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.

Physiotherapy Taping

Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.

Alternatively, your physiotherapist may recommend a supportive brace.

Acupuncture and Dry Needling

Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.

Physiotherapy Exercises

Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.

Biomechanical Analysis

Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.

Hydrotherapy

Aquatic water exercises are an effective method to provide low bodyweight exercises.

Sports Physiotherapy

Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.

Vestibular Physiotherapy

Women's Health

Women's Health Physiotherapy is a particular interest group of therapies.

Workplace Physiotherapy

Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.

Electrotherapy

Plus Much More

Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.

Back & Neck Pain Prevention Tips

Here's some very useful advice to help you prevent back pain and enjoy life to the maximum.

Posture

I'm afraid that your mother was right. If you slouch you'll end up with problems. Just one of those problems is back pain. You'll find other problems elsewhere on this website. Think "Grow Tall".  Imagine that you have a string screwed onto the back the back of your head, just above your hairline. Then think that someone is dragging you up off the chair you are sitting on. Hold this "grow tall" position for 10 seconds and repeat every half hour.As well as greatly reducing your chances of back pain you'll note that your chest has lifted, shoulders are relaxed, chin is tucked in, head is level and stomach muscles have contracted.  Not bad for such a simple exercise. This posture can be repeated in sitting, standing, sleeping, walking or running. Try it and physio will work for you too!

Lifting

The best method to avoid back pain from lifting is delegation. If this isn't an option for you, try the following:
  • Use a back support to lift loads over 15 to 20kg.
  • Bend at the hips and knees with your feet shoulder-width apart.
  • Firmly grip the load and hold it close to your body.
  • Think "grow tall" to tighten your stomach muscles and look upwards to straighten your back.
  • Stand using your strong thigh and buttock muscles to lift.
  • Once upright, turn by using your feet. Avoid twisting your back.

Sitting

Use the "grow tall" principle each 15 to 30 minutes while sitting. A supportive chair or lower back cushion is essential if you must sit. If possible don't stay seated for too long. Regularly stand up, stretch your back and walk short distances for a variety of posture. We were, after all, designed to hunt and forage - not sit in front of a computer!

Exercise

Fitness has many benefits. Stronger, more flexible muscles and less weight to stress the bones and discs. PhysioWorks specialises in the provision of exercise programs to keep your back flexible, strong and painfree. Exercise can involve aspects of flexibility, strengthening and postural control.Consider Real Time Ultrasound Retraining to ensure you are doing it right!

Sleeping

A quality pillow and mattress are necessary for a healthy spine. You do spend somewhere between one-quarter (1/4) and one-third (1/3) of your life sleeping.Do it in comfort!  You'll need to consider a new mattress if you wake up through the night or in the morning with back pain.  Please ask your PhysioWorks therapist for advice at your next visit.

Driving

Use the "grow tall" principle each 15 to 30 minutes while driving. The combination of sitting and bumpy roads are a recipe for back pain. A  lower back cushion is essential if you must drive any distance.If possible don't stay seated for too long. Regularly break your travels to have a walk and perform simple stretching exercises for a variety of posture and a healthy spine. We were, after all, designed to hunt and forage - not sit in front of a computer!

What are the Symptoms of a Heart Attack?

Some heart attacks are sudden and intense — the "movie heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:chest painShortness of breath. May occur with or without chest discomfort.Chest discomfort. Most heart attacks involve discomfort or heaviness in the centre of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one (commonly left) or both arms, the back, neck, jaw or stomach.Other signs: These may include breaking out in nausea or vomiting, cold sweat, or dizziness/lightheadedness.If you think you or someone with you is having a heart attack, Call 000 Immediately!Don't wait longer than a few minutes (no more than five) before calling for help. Call 000 ... Get to a hospital urgently.

What are the Symptoms of Chest Pain originating from your spine?

Your spine is a prevalent cause of chest pain, which can be fixed by treatment of your thoracic spine and rib cage. However, chest pain originating from your spine won't kill you, but a heart attack can!Spinal Discs can refer pain through your chest wall like a knitting needle. Coughing or Sneezing hurts.Thoracic Facet Joints refer pain around your rib cage. Trunk movements will aggravate or ease your pain.Rib Joints send pain down and around your rib cage. Pain can increase with coughing, deep breathing and trunk or shoulder movements.Back Muscles will generally be more painful in sustained postures, e.g. sitting at a computer. These are commonly felt between your shoulder blades and can be relieved by massage.

What to Do Next?

As mentioned earlier, if you suspect a heart attack, Call 000 immediately and get to hospital straight away. If your symptoms are not heart attack related, consult your physiotherapist for an assessment of your spinal and chest joints and muscles. Most of your muscular or thoracic and rib joint pain will be relieved after your very first consultation.For more information, please consult your doctor or physiotherapist.

More info:

Thoracic & Chest Pain

What are the Benefits of Good Posture?

good-posture-sitting

Good Posture:

  • Keeps your bones and joints in the correct alignment.
  • Helps to decrease the abnormal wearing of joint surfaces.
  • Decreases the stress on the ligaments holding the joints of the spine together.
  • Prevents the spine from becoming fixed in abnormal positions.
  • Prevents muscle fatigue.
  • Prevents any backache and muscular pain.
  • Contributes to a competent and confident appearance.

To Achieve Good Posture You Will Require the Following:

  • Good muscle flexibility
  • Normal motion in the joints
  • Strong postural muscles
  • A balance of muscles on both sides of the spine
  • Awareness of your posture, plus knowledge of proper postural position, which leads to conscious correction.
Practise the correct posture for standing, sitting, and lying down (as described below) to gradually replace your old position.

What is Good Posture?

Standing with the good posture looks and feels fantastic, plus it's very healthy for your joints, muscles, bones, blood circulation and most importantly, your self-esteem. That's why proud and confident people stand tall with excellent posture. It's a habit!How you hold your body in space is your posture. Your posture is a direct result of the postural habits that you commonly exhibit. You can choose to hold good posture or poor posture. Gravity is your worst enemy while standing or sitting. You could also refer to this as your spinal posture, back or neck posture.The good news for you is that you can quite easily change your postural habits and train your body to sit, stand, walk, and even rest in great postures. Good posture also places the least strain upon your supporting muscles and ligaments.But, no one posture is good to maintain all day. As a human, you were designed to move from posture to posture to avoid muscle fatigue and abnormal sustained tissue loading. This means that your best posture is your next posture!

Benefits of Good Posture

Good posture:
  • Prevents postural muscle fatigue.
  • Correctly aligns your joints and bones to encourage efficient muscle activity.
  • Helps minimalise joint stress.
  • Avoids passive ligament overload.
  • Prevents backache, neckache and muscular pain.
  • Contributes to your enhanced confidence and a good appearance!
Standing comfortably with good posture should feel natural and energy efficient. Bad postural habits can cause a few muscular aches and pains for a few days during the early transition (posture habit change) phase. You may experience temporary joint or muscle discomfort or fatigue as your joints realign, ligaments stretch and postural muscles start working. The good news is that if you keep at maintaining a good posture your body will quickly adapt and you'll feel more comfortable and strong in your new normal posture.Plus... the up side is that not only will you be less likely to suffer pain, you'll look confident and feel fantastic too!

How to Improve Your Standing Posture:

The number one tip to achieve a great standing posture is to simply"stand tall"! All the muscles that you need to push you taller are the same ones that improve your posture.
  • Stand tall!
  • Extend your head directly up (think balloon lifting your head with a string in the top of your scull) - but keep your chin tucked in. Avoid tilting your head forward, backward or sideways.
  • Your earlobes will line up with the middle of your shoulders.
  • Keep your shoulders back, your knees straight and your back straight.
  • Let arms hang naturally down the sides of the body
  • Lightly draw in your core stomach muscles. Avoid tilting your pelvis forward.
  • Avoid locking the knees
  • Ensure your feet arches are in a neutral (not flat) position.
  • Stand with weight over the the centre of your feet.
  • Stand with your feet slightly apart (shoulder-width).
  • When standing for a sustained periods, shift your weight from one foot to the other, or stand in walk stand and rock your weight from your front to back foot.

How to Quickly Check Your Standing Posture

Stand against a wall with shoulders and bottom touching wall. The rear of your head should lightly touch the wall.

How to Correct Your Posture?

If you experience discomfort in the above test and you can't easily correct your posture, you may have some restriction of joint, ligament or muscular movement. All of these problems can be quickly assessed and quickly improved by your physiotherapist. Please consult them for advice.Having difficulty maintaining a normal upright posture? You are probably suffering from reduced muscle endurance or strength. But these can both be easily improved with some practice of the right exercises. Your physiotherapist is an expert in prescribing the best postural exercises for you in a stage-appropriate manner to help your improve your posture without causing unnecessary pain or injury.You physiotherapist may also advise a posture brace or prescribe some posture taping to assist you to quickly achieve and maintain a good posture.Contact your physiotherapist for posture advice specific to you and your needs.

What is the Best Standing Posture?

Standing with your best posture not only looks and feels fantastic, but it's also very healthy for you.Great posture is the best thing for your muscles, joints, bones, blood circulation and most importantly, your self-esteem. That's why proud and confident people stand tall with excellent posture. It's a successful habit!Good posture also places the least strain upon your supporting muscles and ligaments.How you hold your body in space is your posture. Your everyday posture is a direct result of the everyday postural habits. You can choose to hold good posture or poor posture. The constant compressive weight of gravity is your worst enemy while standing or sitting. You could also refer to this as your spinal posture, back or neck posture.It's actually quite easy to improve your postural habits. But it is a habit and researchers suggest that it takes 10000 attempts to create a habit. That's a good or a bad habit! Why not start the new you with a proud and posture perfect body today?

What is Your Best Posture?

Humans were always designed to move and be versatile. You were designed to move from posture to posture to avoid muscle fatigue and abnormal sustained tissue loading. When we were hunters and gatherers it was easy. But, with specialised jobs and postures, we tend to become static for too long these days and that causes postural fatigue, which leads to posture failure. This means that your best posture is your next posture! 

Benefits of Good Posture

Good posture:
  • Prevents postural muscle fatigue.
  • Correctly aligns your joints and bones to encourage efficient muscle activity.
  • Help minimalise joint stress.
  • Avoids passive ligament overload.
  • Prevents a backache, neckache and muscular pain.
  • Contributes to your enhanced self-esteem!
Your ideal standing posture should be comfortable, easily attained and maintained. Your best posture should feel natural and be energy efficient. Bad postural habits can cause a few muscular aches and pains for a few days during the early transition (posture habit change) phase. During this period you can experience some temporary joint or muscle discomfort. These discomforts are related to mild joint adaptation as your joints realign, ligaments stretch and postural muscles start working. The good news is that if you keep at maintaining a good posture your body will quickly adapt and you'll feel more comfortable and strong in your new normal posture.Plus... the upside is that not only will you be less likely to suffer pain, you'll look confident and feel fantastic too!

How to Improve Your Standing Posture:

If I had to tell you one "switch" tip, it is simply to "stand tall" whenever you think about it. The muscles that you use to stand taller are exactly the same muscles that improve your posture.
  • Stand tall!
  • Think tall neck (ballerina or model style)- but keep your chin tucked in. Avoid tilting your head forward, backward or sideways.
  • Your earlobes will line up with the middle of your shoulders.
  • Keep your shoulders back, your knees straight and your back straight.
  • Let arms hang naturally down the sides of the body
  • Lightly draw in your core stomach muscles. Avoid tilting your pelvis forward.
  • Avoid locking the knees
  • Ensure your feet arches are in a neutral (not flat) position.
  • Stand with weight over the centre of your feet.
  • Stand with your feet slightly apart (shoulder-width).
  • Shift your weight from one foot to the other when standing for a sustained periods. Alternatively, stand in a walk-stand and rock your weight from your front to back foot.

How to Quickly Check Your Standing Posture

Stand against a wall with shoulders and bottom touching the wall. The back of your head should lightly touch the wall. If you can't do this without pain or strain, you may have some restriction of some spinal joints, ligament or some muscle tightness. All of these problems can be quickly assessed and quickly improved by your physiotherapist with some joint mobilisations, stretches, massage and/or strengthening exercises. Please consult your physiotherapist for specific advice regarding your posture.

Posture Fatigue?

Having difficulty maintaining your normal upright posture? You are probably suffering from reduced muscle endurance or strength. Postural muscle fatigue can be improved quite easily with repetitive contraction and periodic posture breaks. This will help to strengthen and improve your postural muscle endurance.Your physiotherapist is a professional in prescribing the best postural exercises for you in a stage-appropriate manner.  They may consider temporarily prescribing you with a posture brace or prescribe some posture taping to assist you to transition, achieve and maintain the best posture for you.
A posture brace can help you position your shoulder blades into a better posture and allow you to return to everyday activities sooner. However, we don’t usually encourage their long-term use because research has shown that your shoulder and upper back muscles will weaken as you become reliant on the brace.  There are better ways that are exercise-based.Children's posture, in particular, can be improved by wearing a posture brace for an hour or two a day while studying to encourage awareness of a good posture.

More Information about Posture Braces

Back Tone 4000: Posture Trainer

A Biofeedback Device

Re-train your body to great posture in just 20 minutes a dayGood Posture makes you look great, feel more energetic and project confidence. It also helps prevent injury and reduce pain.We all want good posture but it can be so hard to achieve. That's because acquiring good posture involves not only learning new movements, but changing life-long habits as well.Just knowing how to correct your posture is not enough to achieve a change in your actual habit. Our body uses learnt motor patterns to perform everyday activities. When we sit, stand, walk or move - our body follows previously learnt motor patterns. If your body has learned to slouch - that's what it will do. BackTone helps you re-train that motor pattern.

What is BackTone?

The BackTone 4000 is the latest biofeedback device for re-training postural habits. Worn for short periods daily, BackTone beeps whenever the wearer slouches. Straightening up turns the beep off. Users wear their BackTone during everyday simple tasks.Wear the BackTone for about 20 minutes at a time during everyday tasks. Without even thinking about your posture, you will straighten up whenever the BackTone beeps.The New BackTone 4000 has:
  • 4 -5 second vibration option for use in noisy environments
  • New strapping configuration for more active tasks
  • Firmer strapping and rubber-backed waist band for less slippage
  • Easy change battery

BackTone Benefits

  • Can be worn at work - the sound emitted is low volume thus does not distract others
  • The backTone 4000 now has a vibration mode for noisy or discrete environments
  • Not cumbersome, easy to put on, no cleaning
  • Wear outside of clothing
  • Not a ‘support’ but a training device (reusable)

 Features of the New BackTone 4000

 
  • Vibration Option allows use in noisy or quiet environments
  • New strapping configuration:
    • Allows wearing during more active tasks.
    • Suits clients with sloping shoulders
    • Allows adjustment for wider range of body shapes
  • Rubber backing on rear waist helps to anchor BackTone
  • Louder, deeper beep (plus vibration option) allows use by people with hearing problems
  • Attractive new packaging and instruction guide

Health Practitioner Tips

Backtone Retrains Posture Habits Like No Other Strategy.Allow Sufficient Time
  • It takes at least 21 days to change any habit. Wear BackTone for 20 mins, a couple of times a day for as long as you like – and actually change the habit.
Use a Train/Feedback/Practice Regime
  • Wear BackTone to learn good posture during activity. Then REMOVE IT and practice without the feedback. Daily non-wearing is just as important as wearing. This allows the training to naturally flow into everyday activities.
Avoid Fatigue
  • BackTone is designed to be easily removed by the user before their muscles fatigue. Once muscles tire they won’t learn much at all. In fact, muscle fatigue may actually contribute to slouching and slow down the learning process.
User Friendly
  • BackTone is easily adjusted by the user even during a single training session. This allows them to set the training to their current status and task.
Develop Confidence and Skill
  • The capacity to apply, adjust and remove the device yourself encourages users to notice and manage their own posture. BackTone users will know when they’re slouching and do something about it, and will tend to alter environments such as computer setup, office chairs and seating of their own accord.
BackTone gives you the tools to provide a comprehensive program that results in real change in posture habits
You've just added this product to the cart:

Do NOT follow this link or you will be banned from the site!