Thoracic Outlet Syndrome

 Thoracic Outlet Syndrome

Thoracic outlet syndrome is a condition that involves pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip. The thoracic outlet is the area between the rib cage and collar bone. Thoracic outlet syndrome is a rare condition that involves pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip. The thoracic outlet is the area between the rib cage and collar bone.

Causes, incidence, and risk factors

Blood vessels and nerves coming from the spine or major blood vessels of the body pass through a narrow space near the shoulder and collarbone on their way to the arms. As they pass by or through the collarbone (clavicle) and upper ribs, they may not have enough space.

Pressure (compression) on these blood vessels or nerves can cause symptoms in the arms or hands. Problems with the nerves cause almost all cases of thoracic outlet syndrome.

Compression can be caused by an extra cervical rib (above the first rib) or an abnormal tight band connecting the spinal vertebra to the rib. Patients often have injured the area in the past or overused the shoulder. People with long necks and droopy shoulders may be more likely to develop this condition because of extra pressure on the nerves and blood vessels.

 Types of Thoracic Outlet Syndrome

True neurologic: caused by congenital anomalies, generally occurs in middle-aged women and almost always on one side of the body

Disputed TOS: also called common or non-specific TOS : caused by injury to the nerves in the brachial plexus

Arterial TOS: occurs on one side of the body. It affects patients of both genders and at any age but often occurs in young people.

Venous TOS: a rare disorder that affects men and women equally. The exact cause of this type of TOS is unknown. It often develops suddenly, frequently following unusual, prolonged limb exertion.

Traumatic TOS: may be caused by traumatic or repetitive activities such as a motor vehicle accident or hyperextension injury Causes

 Symptoms of Thoracic Outlet Syndrome

Pain, numbness, and tingling in the little and ring fingers, and the inner forearm

Pain and tingling in the neck and shoulders (carrying something heavy may make the pain worse)

Signs of poor circulation in the hand or forearm (a bluish color, cold hands, or a swollen arm)

Weakness of the muscles in the hand

Physiotherapy Management of Thoracic Outlet Syndrome

TOS SHARANS Rehabilitation Protocol management of Physiotherapy been followed which has been graded into 4 phases which are interlinked to each other.

Phase 1 - Severe discomforts in the initial stage

Management - Myotherapy soft tissue mobilization, neural mobilization, rib mobilization, clavicular mobilization, scapula thoracic mobilization and physiotherapeutic modalities like IFT, US followed by assisted stretches.

Phase 2 - Moderate discomforts in the upper limb and neck region.

Management -It is a follow up of phase 1 which includes more self-stretching exercises, range of motion exercises, relaxing techniques like breathing exercises, Alexander techniques and yoga therapy.

Phase 3 - Mild discomforts

Management - In this phase continue with self-stretching exercises, free exercises and start of with progressive strengthening exercises followed by relaxation techniques.

Phase - 4 - Maintenance phase

Management-This consists of postural maintenance, generalized whole body stretching and strengthening exercises in order to maintain the length and strength of muscle.

Adequate micro and macro brakes should be taken in between work
Do the stretches and strengthening exercise at least thrice a week.
If there is any flare up of symptoms in this phase (phase 4) stop all the exercises and immediately consult a physiotherapist for further clarification.