Thoracic Outlet Syndrome
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).
Vascular Thoracic Outlet Syndrome
- Pins & needles, numbness in arm and hand
- Decreased or absent arterial pulse
- Swelling, coldness, colour change in arm and hand
- A feeling of stiffness, heaviness fatigue in the arm (Watson et al., 2009)
Neurological Thoracic Outlet Syndrome
- Pain in the 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 the hand
- Muscle spasms in arm/hand
- A feeling of stiffness, heaviness, fatigue in the arm
- Pain at rest and night pain
- Less commonly dizziness, headaches, vertigo (Watson et al., 2009)
Risk Factors for Thoracic Outlet Syndrome
- Bony abnormalities, e.g. abnormal first rib, cervical rib
- 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 manoeuver, Roo’s test or Adson’s test.
If you suspect thoracic outlet syndrome, you may consider cervical spine X-rays to evaluate the presence of a cervical rib or prominent C7 transverse process that may contribute 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 the 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
- Scheuermann's Disease
- Spinal Stenosis
- Rib Stress Fracture
Nerve-related / Referred Pain
What is the PhysioWorks Difference?
You'll be impressed with the experienced physiotherapists, massage therapists, allied health team and reception staff who represent PhysioWorks.
To ensure that we remain highly qualified, PhysioWorks is committed to participating in continuing education to provide optimal care.
If you've been searching for health practitioners with a serious interest in your rehabilitation or injury prevention program, our staff have either participated or are still participating in competitive sports at a representative level.
We also currently provide physiotherapy and massage services for numerous sports clubs. Our experience helps us understand what you need to do to safely and quickly return to your sporting field, home duties, or employment.
How You'll Benefit from the PhysioWorks Difference?
At PhysioWorks physiotherapy and massage clinics, we strive to offer our clients quick, effective and long-lasting results by providing high-quality treatment.
We aim to get you better quicker in a friendly and caring environment conducive to successful healing.
With many years of clinical experience, our friendly service and quality treatment is a benchmark not only in Brisbane but Australia-wide.
What are Some of the BIG Differences?
Our therapists pride themselves on keeping up to date with the latest research and treatment skills to ensure that they provide you with the most advantageous treatment methods. They are continually updating their knowledge via seminars, conferences, workshops, scientific journals etc.
Not only will you receive a detailed consultation, but we offer long-term solutions, not just quick fixes that, in reality, only last for a short time.
We attempt to treat the cause, not just the symptoms.
PhysioWorks clinics are modern thinking. Not only in their appearance but in the equipment we use and in our therapists' knowledge.
Our staff care about you! We are always willing to go that 'extra mile' to guarantee that we cater to our client's unique needs.
All in all, we feel that your chances of the correct diagnosis, the most effective treatment and the best outcomes are all the better at PhysioWorks.
Common Sources of Spinal Pain & Injury
- Neck Pain - Cervical Spine
- Upper Back Pain - Thoracic Spine
- Lower Back Pain - Lumbar Spine
- Sacroiliac Pain - SIJ
- Scheuermann’s Disease
- Spinal Stenosis
- Rib Stress Fracture
Nerve-related / Referred Pain
Youth Spinal Pain
Teenager Neck & Back PainTeenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control. The competitive athlete and most individuals who exercise regularly or maintain a level of fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Your physiotherapist can assist the resolution of any deficits in this area. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions. Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these type of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
PelvisCommon Youth & Teenager Sports Injuries Common Youth Leg Injuries Common Youth Arm Injuries
Article by P.XuAs we slowly start getting into the cooler seasons, many people will begin to notice sore joints waking up in the morning, or that movement has become stiff, or even headaches increasing in frequency or severity. Why is this? It turns out that cold weather can have a significant impact on your body’s tissues. Notably, the connective tissue gives our muscles and joints the ability to move as they do, called elastin. As the name suggests, elastin is one of the critical components that provide our joints and muscles with the ability to bend, stretch, and move as they need to get you through the day.
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, allow patients to manage pain and prevent disease for people of all ages. Physiotherapists help encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing daily living activities 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
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Soft Tissue Techniques
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, to name a few.
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 acupuncture and dry needling to assist pain relief and muscle function.
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.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
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.
Aquatic water exercises are an effective method to provide low bodyweight exercises.
Sports physio requires an extra level of knowledge and physiotherapy to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.
Women's Health Physiotherapy is a particular interest group of therapies.
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.
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 problem, please contact your PhysioWorks team.
How is Kinesiology Tape Different from Conventional Strapping Tape?Rigid strapping firmly wraps around your injured structures. Most standard strapping tapes are non-elastic. They aim to provide rigid support and restrict movement. These rigid strapping tapes can only be worn for short periods, after which you must remove them to restore your circulation. and mobility. Alternatively, kinesiology tape has some unique elastic properties that allow it to provide active support, protect muscles or joints, and allow a safe and functional range of motion. Rather than being entirely wrapped around injured joints or muscle groups, kinesiology tape is applied directly over or around the periphery of troublesome areas. This non-restrictive characteristic of kinesiology taping allows most applications to continue for several days. This period reinforces therapeutic benefits to accumulate 24-hours a day for the entire time they’re worn. You can wear kinesiology tape during intense exercise, showering or swimming. It quickly dries after a quick pat with a towel. More info: Strapping & Supportive Taping
Back & Neck Pain Prevention TipsHere's some beneficial advice to help you prevent back pain and enjoy life to the maximum.
PostureI'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 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, the chin is tucked in, the 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 the physio will work for you too!
LiftingThe best method to avoid back pain from lifting is delegation. If this isn't an option for you, try the following:
- Use 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.