Thoracic Outlet Syndrome / TOS (chest/neck nerve impingement)
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Description of Thoracic outlet syndrome

Thoracic outlet syndrome is the result of pinching of nerves, arteries and veins around the neck, chest, ribs and collar bone which result in radiating pain and discomfort in the shoulder, arm and / or hand. Mechanically, pain is a product of tight muscles which compress nerves in the shoulder and arm.

The compression can take place in three “nerve exits” or “gates”:

  • The top exit is called the scalene gate, as it consists of a space between the scalar muscles which due to a hypertonic state are tight and stressed. The tightness of these muscles results in a compression of the nerve which results in discomfort and pain.
  • The middle gate, the space between the first rib and the clavicle (costo-clavicular gate). If the fist rib is held in an upward dysfunction, it results in compression of the nerve which causes discomfort and pain.
  • The lower gate made up of the space between the second and fourth rib and the muscle pectoralis minor (costo-pectoral proten). A hypertonic and thus tight and stressed muscle pectoral minor compresses the nerve towards the rib structure which thusly results in discomfort and pain.
Symptoms of Thoracic outlet syndrome
  • Pain in shoulder and neck.
  • Pain in arm.
  • Pain in hand.
  • Sleeping, pricking and stabbing sensations into the hand.
  • Skin color change in hand and arm.
  • Cold hand.
  • Weak pulse in arm and hand.
  • Weak gripping strength in hand.
  • A pounding sensation at the collar bone.
  • In the worst case a blood clot under the collar bone.
Examination of Thoracic outlet syndrome
  • Analysis / Inspection / Palpation / Movement Test of Force, Active and Passive Range of Motion.
  • Adson Maneuver.
  • Allen Test.
  • Costoclavicular Maneuver.
  • EAST test.
  • Elevation Test.

Several tests are used to conclude where the impingement is taking place to find out whether it is a case of upper, middle or lower thoracic outlet syndrome.

Treatment for Thoracic outlet syndrome
  • Rehab training.
  • Therapy with an expert in thoracic outlet syndrome.
  • Massage / trigger point massage.
  • Spascupreel (2 tabl. 3 g. daily for 9 days).
  • Thermal treatment (heat).
  • Ultrasound (continuous / pulsating).
  • Kinesiology tape.
  • K-Laser.
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