What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome (TOS) is a group of disorders that occur due to the compression of nerves or blood vessels in the space between collarbone and 1^st rib (thoracic outlet).

Thoracic outlet is a passageway for many important structures which includes brachial plexus, subclavian artery and subclavian vein. Brachial plexus has a hourglass shape. The narrowing of the plexus passes under the clavicle and 1^st rib can lead to hypo-mobility (reduce mobility) of plexus which eventually caused irritation with every movement of arm.

Which are few narrowing areas that can lead to the occurrence of TOS?

1. Interscalene triangle: This triangle is bordered by anterior scalene, middle scalene and 1^st Brachial plexus and subclavian artery involved.
2. Costoclavicular triangle: This triangle is bordered by clavicle, 1^st rib and upper border of scapula. Subclavian artery, subclavian vein and brachial plexus involved.
3. Sub-pectoralis minor space: This space involved coracoid process, pectoral minor (chest muscle) and 2-4 ribs. Shortening of pectoral minor muscles can leads to compression of nerves.

What is the symptoms of TOS? 

• Pain over arms, neck, shoulders
• Tingling sensation
• Numbness
• Weakness
• Swelling / Heaviness

4 Exercises to help in relieving TOS’s symptoms

1. Anterior Scalene Stretching

• Put one arm at the back
• Lie the other side of ear toward the shoulder
• Look up to the sky by turning the head
• Drop the head backwardly
• Hold for 20s, repeat for 3 times

2. Middle Scalene Stretching

• Put one arm at the back
• Lie the other side of ear to the shoulder
• Use the other hand to press the head downwardly until feel a gentle stretch
• Hold 20s, repeat for 3 times

3. Posterior Scalene Stretching

• Put one arm at the back
• Lie the other side of ear toward the shoulder
• Look downwardly towards the pocket direction
• Use the other hand to press the head downwardly until feel a gentle stretch
• Hold for 20s, repeat for 3 times

4. Pectoral Minor Muscles Stretching

• Stand in front of the corner
• Place both arm on the wall (make sure the forearm are stick to the wall)
• Place the arm higher (more than 90 degree)
• Push the body forwardly until a gentle stretch over the chest area
• Hold for 20s, repeat for 3 times

Prepared by:

Craig Lee Choon Yik

Your Physio Cheras