Table of ContentsView AllTable of ContentsAssessmentPhysical TherapyPost-Surgery TherapyExercisesPreventionOutlookFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Assessment
Physical Therapy
Post-Surgery Therapy
Exercises
Prevention
Outlook
Frequently Asked Questions
Thoracic outlet syndrome (TOS) is a cluster of disorders that occur when the nerves, arteries, or veins that run between your clavicle (collarbone), highest rib, and two of the scalene muscles are pinched or compressed. It is named for the pathway (the thoracic outlet) through which these blood vessels and nerves travel en route to your arms and hands.
While anyone can get TOS, individuals participating in repetitive overhead activities or sports, those with poor posture or weak shoulder muscles, people in their middle ages, and females are the most likely to experience it.
Fortunately, in many cases, the symptoms of thoracic outlet syndrome can be addressed with physical therapy. This article will discuss physical therapy assessment, goals, exercises, and outcomes for thoracic outlet syndrome.
Assessing Thoracic Outlet Syndrome
One of the first steps a doctor or physical therapist takes when assessing TOS is to figure out which version of the condition you have. There are three unique varieties, each with its own specific presentation.
A cluster of tests (including the Adson test or Wright test) that assesses changes in your radial (wrist) pulse while turning your neck or elevating your arm over your head can also be used to diagnose the cause of your TOS.
An Overview of Thoracic Outlet Syndrome
Physical Therapy for Thoracic Outlet Syndrome
Goal One: Nerve Compression Reduction
The first step in controlling your TOS symptoms (such as pain and numbness) is to reduce the amount of compression on the nerves of the brachial plexus. PT can help you accomplish this goal in a number of different ways.
First, soft tissue massage can be performed on several neck and chest muscles to relax these structures. Specifically, thepectoral,trapezius,scalene, levator scapulae,sternocleidomastoid, and suboccipital muscles are usually targeted.
Goal Two: Strengthening
While the pressure reduction techniques described above are important for symptom reduction, strengthening activities also play a crucial role in preventing your symptoms from reoccurring. Generally, your physical therapist will have you perform exercises that target the muscles in the shoulder and shoulder blade (scapular) regions.
Building strength in these areas can help improve your sitting and standing posture and reduce the likelihood that the nerves that travel through the thoracic outlet become re-pinched.
At a bare minimum, four to six weeks of PT are usually attempted before your physician would consider a more invasive injection or surgical intervention. That said, it may take up to four to six months of physical therapy to fully relieve the arm, hand, or finger symptoms you are experiencing.
Post-Surgery Physical Therapy
In certain situations, physical therapy and other conservative measures fail to improve the symptoms of TOS and surgery is needed.
During this time, it is important to protect the structures in the thoracic outlet area. Your physical therapist may also teach you different ways to sit or sleep that help reduce the chances that your pain levels increase. After about a month, gentle stretching and nerve gliding exercises may be initiated and massage may be performed near the site of the surgery.
Strengthening exercises for the shoulder and postural muscles are generally not initiated until the three- to four-month mark, though the rehab protocol will vary from surgeon to surgeon. Some begin postural muscle strengthening after a month, but weight lifting is restricted for three months.
Ultimately, it can take up to six to nine months for a full return to higher-level exercise and sporting activities.
Get Your Shoulder Rehab Started With the Right Exercises
Thoracic Outlet Syndrome Exercises
During the course of physical therapy for thoracic outlet syndrome, several specific exercises are used to manage your symptoms. Some of the hallmark techniques traditionally utilized are listed below.
Verywell / Joules Garcia
Postural Stretching
Falling into a rounded shoulder andforward head posturecan cause your neck and chest muscles to become tight. Maintaining this posture for a long period of time can also compress the structures that travel through the thoracic outlet.
Because of this, your therapist will typically teach you stretches for the chest (pectoral), neck (scalene, sternocleidomastoid, suboccipital), and scapular (levator scapulae, trapezius) muscles. Gaining flexibility in these structures can help you stay in a better sitting or standing posture and is one of the keys to improving your TOS symptoms.
Scapular Strengthening Exercises
In addition to stretching, strengthening the scapular muscles in your upper and mid-back can help you maintain amore erect posturewhile you are sitting and standing. This, in turn, can help prevent symptom reoccurrence.
Lying on your stomach and performing aprone shoulder row or prone shoulder extensionexercise can target the muscles that bring your shoulder blades into a down (depressed) and back (retracted) position.
Similarly, doing a reverse fly or rested external rotation movement with an elastic band can also activate these important structures.
Finally, thepush-upplus exercise, which encourages you to bring your shoulder blades into a forward or protracted position at the end of the movement, is another effective technique.
During your time in therapy, your physical therapist will walk you through a wide variety of exercises that can address any weakness that may be contributing to your thoracic outlet syndrome symptoms.
Nerve Gliding Techniques
To do this, the therapist will instruct you on gently moving your arm between a position that tenses the nerve and one that relaxes it. Alternating between these two arm movements can help relieve some of your TOS symptoms over time.
If you have experienced the symptoms of thoracic outlet syndrome in the past, there are several steps that you can take to prevent the condition from reoccurring.
First, try to avoid carrying heavy backpacks, bags, or purses over the affected shoulder. Doing so can push down on your collarbone (clavicle) and cause the structures in this area to become compressed.
In addition, continue to perform the stretching and strengthening exercises your physical therapist teaches you, even after your symptoms resolve. While these exercises can provide symptom relief in the moment, they can also help you maintain good posture and reduce the likelihood that your thoracic outlet symptoms reappear.
If left untreated, thoracic outlet syndrome can lead to serious consequences like blood clots, permanent loss of nerve function, and chronic pain or swelling of the arm. Fortunately, in most cases, this is a very treatable condition.
Typically, neurogenic TOS is well addressed with a combination of physical therapy, muscle relaxants, pain medication, and (occasionally) injections. Conservative treatment, however, may take up to six months to provide significant relief.
Venous thoracic outlet syndrome typically does not respond well to physical therapy. Instead, it is usually initially treated with a combination of medications that help dissolve any existing blood clots and keep future ones from forming.
Finally, in the case of arterial thoracic outlet syndrome, surgery is usually necessary to provide symptom relief.
Summary
Physical therapy can help with the symptoms of thoracic outlet syndrome. Depending on the type, surgery may be needed, with physical therapy both before and after. Physical therapy begins with range of motion exercises, stretching, and mobilization exercises. It then may progress to strengthening exercises for the shoulder.
A Word From Verywell
Regardless of which type of thoracic outlet syndrome you have, you can take comfort in knowing that the condition is usually treatable. In the case of neurogenic TOS, physical therapy can help resolve your symptoms and return you to the activities you love.
What physical therapy exercises are recommended to relieve thoracic outlet syndrome?
Physical therapy for thoracic outlet syndrome typically focuses on three types of exercises. First, postural stretches are prescribed to improve the flexibility in the muscles that surround the affected nerves.
Next, nerve flossing or gliding techniques help free your nerves from any restrictions that are keeping them from moving normally. Finally, shoulder and shoulder blade strengthening activities help improve your posture, provide symptom relief, and prevent your TOS from recurring.
How long do you need physical therapy to help with thoracic outlet syndrome?
The amount of time it takes for PT to help the symptoms of TOS varies from person to person. That said, it is not unusual to see progress in as little as four to six weeks. In some cases, however, it can take four to six months to completely resolve your symptoms.
How many sessions of physical therapy do you need after surgery for thoracic outlet syndrome?
Depending on the activities you are looking to return to, rehab after a thoracic outlet syndrome surgery can last for six months or more. Early on, your therapist may want to see you one to two times per week while you are initially recovering from surgery.
As time goes on and you enter the later phases of PT, however, the sessions usually become less frequent. During this time, you may only see your therapist once weekly or even once every few weeks to update your home program.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cleveland Clinic.Thoracic outlet syndrome (TOS).American Academy of Orthopaedic Surgeons.Thoracic outlet syndrome.Kuhn JE, Lebus GF, Bible JE.Thoracic outlet syndrome.J Ame Acad Orthopaed Surg. 23(4):222-232. doi:10.5435/JAAOS-D-13-00215Buller LT, Jose J, Baraga M, Lesniak BP.Thoracic outlet syndrome: current concepts, imaging features, and therapeutic strategies.Ame J Orthoped. 44(8):376-382.Ohman JW, Thompson RW.Thoracic outlet syndrome in the overhead athlete: diagnosis and treatment recommendations.Curr Rev Musculoskelet Med. 13(4):457-471. doi: 10.1007/s12178-020-09643-x
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cleveland Clinic.Thoracic outlet syndrome (TOS).American Academy of Orthopaedic Surgeons.Thoracic outlet syndrome.Kuhn JE, Lebus GF, Bible JE.Thoracic outlet syndrome.J Ame Acad Orthopaed Surg. 23(4):222-232. doi:10.5435/JAAOS-D-13-00215Buller LT, Jose J, Baraga M, Lesniak BP.Thoracic outlet syndrome: current concepts, imaging features, and therapeutic strategies.Ame J Orthoped. 44(8):376-382.Ohman JW, Thompson RW.Thoracic outlet syndrome in the overhead athlete: diagnosis and treatment recommendations.Curr Rev Musculoskelet Med. 13(4):457-471. doi: 10.1007/s12178-020-09643-x
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cleveland Clinic.Thoracic outlet syndrome (TOS).American Academy of Orthopaedic Surgeons.Thoracic outlet syndrome.Kuhn JE, Lebus GF, Bible JE.Thoracic outlet syndrome.J Ame Acad Orthopaed Surg. 23(4):222-232. doi:10.5435/JAAOS-D-13-00215Buller LT, Jose J, Baraga M, Lesniak BP.Thoracic outlet syndrome: current concepts, imaging features, and therapeutic strategies.Ame J Orthoped. 44(8):376-382.Ohman JW, Thompson RW.Thoracic outlet syndrome in the overhead athlete: diagnosis and treatment recommendations.Curr Rev Musculoskelet Med. 13(4):457-471. doi: 10.1007/s12178-020-09643-x
Cleveland Clinic.Thoracic outlet syndrome (TOS).
American Academy of Orthopaedic Surgeons.Thoracic outlet syndrome.
Kuhn JE, Lebus GF, Bible JE.Thoracic outlet syndrome.J Ame Acad Orthopaed Surg. 23(4):222-232. doi:10.5435/JAAOS-D-13-00215
Buller LT, Jose J, Baraga M, Lesniak BP.Thoracic outlet syndrome: current concepts, imaging features, and therapeutic strategies.Ame J Orthoped. 44(8):376-382.
Ohman JW, Thompson RW.Thoracic outlet syndrome in the overhead athlete: diagnosis and treatment recommendations.Curr Rev Musculoskelet Med. 13(4):457-471. doi: 10.1007/s12178-020-09643-x
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