Thoracic Outlet Syndrome (TOS)


Thoracic Outlet Syndrome
a.k.a. TOS

Thoracic outlet syndrome is a term that describes several syndromes that occur from the compression of nerves, veins, or arteries in the upper chest and lower neck. There are a number of neurovascular structures that run through the thoracic outlet — the area between the collar bone and the first rib.

The thoracic outlet is pretty crowded, which makes it susceptible to compression and the symptoms that follow with TOS. Each of the veins, arteries, and nerves in the area have to compete for space with muscle structures like the scalene muscles, which run down the neck and connect to the first rib, and the pectoralis minor.

Symptoms of TOS vary depending on what is compressed and to what degree. Usually patients experience pain in the neck, chest, or shoulders. They might also have weakness or numbness in the arm or hand.

Some people are born with anatomical abnormalities that crowd the thoracic outlet even more. This could be a cervical rib, clavicular hypomobility, or soft tissue abnormalities, all of which increase the likelihood of TOS.
It’s estimated that 8% of the population deals with TOS. The condition is 3-4 times more likely in women because of anatomical factors, like a more narrow thoracic outlet and a

greater likelihood of drooping shoulders as a result of additional breast tissue. Posture is definitely a factor in TOS, but trauma and fractures to the rib or clavicle are also common mechanisms of injury for athletes.

There are three types of TOS, distinguished by what is compressed — arterial, venous, and neurogenic. Each has their own causes and their own symptoms. We’ve treated all three many times at MOTUS, and have narrowed down the most effective ways to deal with each.

Most of the time, TOS occurs in healthy, active people who participate in a sport with a lot of overhead activity. Basketball players are at risk of neurogenic TOS. By constantly raising their arms to shoot or block shots, they often compress the nerves in their thoracic outlet. Any athlete playing an overhead sport like volleyball, tennis, swimming, baseball, or softball can be at potential risk.

When we treat TOS, we seek to increase the space in the thoracic through a personalized approach. Our treatment plans usually consist of patient education, exercise to improve strength and posture, and manual manipulation. TOS is a complicated diagnosis because of its different types and presentations, but with our experience we’re able to work with patients and find the right solutions.