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Thoracic Outlet Syndrome: Symptoms And Treatment Options With Physical Therapy

Thoracic Outlet Syndrome: Symptoms And Treatment Options With Physical Therapy

Thoracic Outlet Syndrome: Symptoms And Treatment Options With Physical Therapy

Thoracic outlet syndrome was once a difficult condition to diagnose. Today, however, it is much better understood and treatment options, such as physical therapy, can help alleviate the pain it causes. There are three types of Thoracic outlet syndrome: neurological, vascular, and non-symptomatic. This article will focus on the type that occurs in approximately 95% of cases, neurological thoracic outlet syndrome.

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome occurs when the nerves or blood vessels between your neck and collarbone/axilla area are compressed. The term thoracic outlet refers to the small space these vessels must pass through to exit the thorax (chest) and supply the upper extremities. The thoracic outlet space naturally changes in volume with activity or breathing but it can become cramped and cause compression to the nerves and vessels that run through it.

Symptoms of Thoracic Outlet Syndrome

While each patient may present differently, especially depending on the type of thoracic outlet syndrome, many patients with neurological Thoracic outlet syndrome have similar symptoms. Here is a list of the most common symptoms associated with thoracic outlet syndrome:

  • Pain in neck or shoulder that radiates to arm and hand
  • Numbness or tingling to affected shoulder or arm
  • Weakness to affected extremity
  • Purple-red discoloration and visible superficial veins of the affected side (seen with vascular thoracic outlet syndrome)
  • Blood clot to affected side (seen with vascular thoracic outlet syndrome)
  • Fingers may appear white due to lack of blood flow with accompanying severe pain (vascular thoracic outlet syndrome)
  • Swelling in arm (vascular thoracic outlet syndrome)

Each patient is different so not all symptoms may be experienced, and they may be constant or may come and go.

Causes of Thoracic Outlet Syndrome

There are varying causes for this condition but here are the most common: 

  • Bony abnormalities such as an extra rib (cervical rib)
  • Poor posture
  • Undue prolonged pressure on joints from obesity or carrying heavy bags
  • History of vigorous or chronic repetitive movement/activity
  • Pregnancy
  • Injury or trauma to affected area (falls, motor vehicle accidents, etc.)

Physical Therapy Options 

Exercise and pointed physical therapy focused on the shoulder muscles is the first treatment option for Thoracic outlet syndrome, and studies have found it to be up to 90% successful. Such a program can consist of a variety of stretches, exercises, and postural corrections. Here are some common treatments:

Postural Stretches

These stretches help to reduce neck and shoulder strain and improve flexibility. Here are two common stretches:

  • Chin Tucks
    • Begin in a seated position
    • Position your chin parallel with the floor
    • Retract your head backward
    • Hold this position for 15 seconds
    • Aim for three repetitions
  • Scapular Retraction
    • Begin by standing with your arms at your sides with your head and neck in a neutral position
    • Pull your shoulders back and squeeze your shoulder blades backward and downward
    • Hold this position for 5 to 10 seconds
    • Return to the starting position
    • Aim for 3 repetitions

Strengthening Exercises

Many exercises can be done with minimal equipment such as a resistance band or 2kg weights. Your physical therapist can set up a personal program specific to you. Here is an example of a resistance band exercise:

  • Standing external rotation with resistance band
    • Begin in a standing position with feet shoulder width apart
    • Maintain a neutral spine and keep your shoulders square
    • Hold the resistance band in both hands and place elbows at a 90 degree angle tucked into your sides
    • Push your arms outwards and apart while keeping your elbows tucked into your sides.
    • Hold this position for 5 to 10 seconds
    • Aim for 3 repetitions

Manual Therapy

This can include the mobilization and manipulation of joints to improve your range of motion.

Cardiovascular Exercises

The goal is to improve overall body function and increase circulation. Emphasis should be placed on steady diaphragmatic or deep breathing as this can decrease muscle tension.

All physical therapy programs should be specified to your needs and your therapist can work with you to create the best plan and assist you as you progress. Proper techniques for any exercises will be discussed by your physical therapist to prevent any undue shoulder or neck strain.


Thoracic outlet syndrome can be a painful condition that hinders daily activities. A physical therapy program including strengthening exercises, stretches, and manual therapy performed by a trained physical therapist at Blue Hills Sports & Spine Rehabilitation can help get you on the road to recovery and back to your normal activities without the pain.