Neck and shoulder pain is all too common and can result from poor posture or overuse. But if your pain is accompanied by numbness and tingling, one of the conditions you might be experiencing is thoracic outlet syndrome. While the condition sounds scary, conservative treatment options exist for mild to moderate cases, with physical therapy often being the first line of defense. Our team of experts at EW Motion Therapy can evaluate your symptoms and create a personalized treatment plan to relieve pain and help you move better. Even if you decide our services do not fit your needs, you can still read on to learn what thoracic outlet syndrome is, the effects of the condition, and your treatment options.
What is thoracic outlet syndrome?
Thoracic outlet syndrome (TOS) is a condition that occurs when the nerves or blood vessels in the thoracic outlet, the area between the collarbone and the first rib, become compressed or irritated. This compression can cause various symptoms, including pain, numbness, tingling, and weakness in the arms, neck, and shoulders. TOS can also cause swelling or discoloration of the arm or hand.
There are several different types of TOS, depending on the location of the compression. Neurogenic TOS occurs when the nerves that run from the neck to the arm are compressed, while vascular TOS occurs when the blood vessels in the thoracic outlet are compressed. A mixed type of TOS can also happen when both nerves and blood vessels are compressed.
The exact cause of TOS is sometimes unclear. Still, it can be related to various factors such as physical trauma, repetitive motions, poor posture, and anatomical abnormalities such as a cervical rib or an extra first rib. These factors can cause compression or irritation of the nerves and blood vessels in the thoracic outlet, leading to the development of TOS.
What are the effects of thoracic outlet syndrome?
Symptoms of TOS can vary greatly and can be confusing because they mimic other conditions. The most common symptoms include numbness, tingling, or pain in the neck, shoulders, arms, and hands, weakness or fatigue in the affected arm, and swelling or discoloration of the hand or arm. In severe cases, TOS can lead to blood clots, difficulty breathing, and a weakened grip.
The effects of TOS on movement can be significant. Individuals with TOS may experience difficulty raising their arms, reaching overhead, or performing tasks that require them to hold their arms outstretched for extended periods. They may also experience weakness or fatigue in the affected arm, making it challenging to perform everyday activities such as carrying groceries, typing on a computer, or combing their hair.
What are the treatment options for thoracic outlet syndrome?
The treatment for TOS depends on the condition’s underlying cause and the severity of the symptoms. In mild cases, conservative treatments such as physical therapy, medication, and lifestyle modifications may be enough to alleviate the symptoms. In more severe cases, surgery may be necessary.
Physical therapy is often the first line of treatment for TOS. The primary goal of physical therapy is to reduce pain and inflammation, restore function, and prevent future episodes of TOS. The first step in treating TOS is identifying the underlying cause and developing a personalized treatment plan that addresses the patient’s needs.
Physical therapy treatment for TOS may include manual techniques such as soft tissue mobilization, joint mobilization, nerve gliding, and stretching exercises to help alleviate pain and improve movement. Nerve gliding exercises for thoracic outlet syndrome involve gently stretching and mobilizing the nerves that pass through the thoracic outlet. These exercises are designed to enhance nerve mobility and reduce compression and irritation of the nerves, thereby relieving symptoms such as pain, tingling, and numbness. Your physical therapist may also prescribe strengthening exercises to help improve muscle function and restore mobility. Posture correction and ergonomic modifications can also help reduce the risk of future episodes of TOS, as can avoiding repetitive motions and activities that exacerbate symptoms.
Surgical intervention may be necessary for some cases of TOS that do not improve with non-surgical treatments. It is important to note that the surgical technique used to treat TOS will depend on the underlying cause and severity of the symptoms. Patients should discuss their treatment options with a qualified healthcare provider. Here are some standard surgical techniques used to relieve thoracic outlet syndrome:
- First rib resection: This is the most common surgical procedure used to treat TOS. The first rib is removed during this procedure to relieve pressure on the nerves and blood vessels.
- Scalene muscle release: In some cases, the scalene muscles, located in the neck, can compress the nerves and blood vessels in the thoracic outlet. This surgical technique involves releasing or removing a portion of the scalene muscle to relieve pressure on the nerves and blood vessels.
- Clavicle resection: This surgical technique involves removing a portion of the collarbone (clavicle) to relieve pressure on the nerves and blood vessels in the thoracic outlet.
- Arterial bypass: An arterial bypass may be necessary if the arteries in the thoracic outlet are compressed or damaged. A graft bypasses the damaged artery during this procedure and restores blood flow.
- Thoracic sympathectomy: This surgical technique removes or cuts the sympathetic nerves in the thoracic outlet to relieve pain and improve blood flow.
The proper physical therapy interventions can rectify many cases of TOS if that is the treatment option your doctor feels is the best for your symptoms. A physical therapist can create an individualized treatment plan to relieve pain and help to restore healthy movement. Our team at EW Motion Therapy considers it a privilege to do this for our clients every day at our six locations in the greater Birmingham area and Tuscaloosa. If you are curious about what else physical therapy can do for you, click the button below to download our answers to 20 frequently-asked physical therapy questions.
