Thoracic Outlet Syndrome

The term thoracic outlet syndrome is used to describe a number of conditions in which the underlying cause is compression of the neurovascular bundle (brachial plexus) and associated subclavian vessels, as they traverse the thoracic outlet.

The thoracic outlet is made up of the middle and anterior scalene and first rib and clavicle. These disorders often cause neurological symptoms in the neck arm and hand.(1, 2)

Due to the fact that there is a wide variance in diagnosis of TOS the exact incidence is unknown, estimates are thought to be in the range of anywhere between 3 to 80 cases per 1,000 people.

It occurs more often in women and is found to be more predominant in people who exhibit poor muscular development and poor posture.(3)

Clinical Signs and Symptoms

  • Pain or numbness anywhere from neck down to fingers
  • Weakness
  • Tenderness of scalene muscles
  • Repetitive occupation  that involves repeated hunching forward for may hrs at a time
  • Positive to the above orthopaedic examinations specific for TOS either uni or bi-lateral

Review of Evidence for Management

It is advised that a patient suffering TOS undergo conservative treatment measures for at least 3 months before surgery is considered.

This includes the use of Osteopathy such as Muscle energy techniques, Neural flossing and deep tissue massage to the surrounding musculature(4). 

If these methods are ineffective and the patient is still suffering appropriate surgical methods may be taken depending on each patient presenting a complaint and symptoms displayed.

Common surgeries include excision of the first rib or a complete scalenectomy these often take away the compression affecting the neurovascular bundle and in turn remove patients symptoms.(5)


  1. McKenzie K, Lin G, Tamir S. Thoracic outlet syndrome, part I: a clinical review. Journal of the American Chiropractic Association. 2004;41(1):17-24.
  2. Michael Rubin. Thoracic Outlet Compression Syndromes. 2014 [cited 2014 30th April]; Available from:
  3. Rosenbaum DA. Thoracic Outlet Syndrome. 2014 [cited 2014 19th April]; Available from:
  4. Lowe W. Orthopedic massage : theory and technique. 2nd ed. Edinburgh ; New York: Mosby; 2009. xiii, 296
  5. Nichols AW. Diagnosis and Management of Thoracic Outlet Syndrome. Current Sports Medicine Reports (American College of Sports Medicine). 2009;8(5):240-9.

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