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Thoracic Outlet Syndrome or TOS as it’s called is a type of compression syndrome occurring to the area around the first rib and clavicle. This is where the nerves that service the arm are located as well as the subclavian artery and vein which supply blood circulation to the arm. The most common type of occlusion is caused by the compression of the nerve. This can cause pain, weakness, numbness and/or tingling down into the arm and hand. Less likely to occur are the vascular symptoms of reduced blood flow either in or out of the arm.

Typically we deal with the compressions of the nerves so that’s what I will refer to here. If you do notice your arm is swollen, dark and warm (venous compression) or if it’s cold and pale (arterial compression) please see your Doctor to get a diagnoses prior to your appointment. These types of TOS are a more urgent matter but luckily quite rare. Neurogenic TOS is often painful, to your neck and shoulder, down your arm, and possibly up to the head causing headaches. You may feel like your arm is weak or tired and/or causing a tingling or numbness. Vague symptoms I know, which is why it is usually harder to diagnose, but the symptoms are quite typical of what we see on a daily basis.

Nerve compression is caused by narrowing of the space between the clavicle and first rib, muscular tension – mostly with anterior scalene muscle located at the front of your neck- extra weight around the area or even an extra rib (cervical rib).

What causes this nerve compression can be various things but often neck trauma, such as whiplash or slips/falls, or repetitively poor posture are the reasons we see people the most. When I refer to repetitive poor posture I mean your positioning but also just having a job or hobby where we continuously do the same movements, esp if weight bearing, will put a strain on your body. This can lead to muscular imbalances and misalignment of joints and bones which will cause scar tissue and compression.

Luckily this can be remedied by physical therapy to align and relax the structures and tissues of the area but usually also needs to be fixed through proper muscular and habit retraining.

Don’t worry, sounds all very technical but really this is one of those injuries that can be fixed and not return if you do your homework. If you have these symptoms the key is not to leave it too long as it often gets worse and can take longer to treat. Of course everyone gets the occasional sore shoulder but if heat, ice and stretching doesn’t help please see a health professional so you can reduce the amount of work needed to correct it.

Caroline Iwasaki, RMT