Physical Therapy Management of Thoracic Outlet Syndrome

PHYSICAL THERAPY MANAGEMENT OF THORACIC OUTLET
SYNDROME
Thoracic outlet syndrome describes the compression of neurovascular bundle

comprising of subclavian artery and vein, axillary artery and vein and brachial
plexus at the thoracic outlet. It is a space between the first rib, clavicle and the
scalene muscles. The above are liable to be compressed when this space gets
narrowed either due to hypertrophy of the existing muscles or due to any
other causes such as congenital, trauma, etc.
PHYSICAL THERAPY MANAGEMENT
Non-operative Management of TOS

If the symptoms demonstrate that there is inflammation, treatment is first
directed at eliminating the provoking mechanism and controlling the
inflammation.
Conservative interventions usually precede surgery.
The primary emphasis of management is to decrease the mechanical pressure
by increasing the mobility of tissues in the thoracic outlet region, preventing
recurrence of the compression loads by correcting the postural alignment , and
developing endurance to maintain correct posture.
A program with interventions that specifically address the presenting

impairments should be developed by the clinician.
Secondary or associated complaints such as myofascial trigger points,
glenohumeral joint pathology, cervical pathology, or distal peripheral
neuropathies should be identified and appropriate interventions incorporated
into the program. The following should be considered:
 Patient education
 Teach patient how to modify or eliminate provoking postures and
activities.
 Provide a home exercise program that includes flexibility, muscle
performance and postural exercises.
 Emphasize the importance of compliance to reduce stresses onthe nerve
and vascular structures.
 Teach posture correction.
 Thermotherapy
 For pain relief.
 For muscle relaxation.
 Nerve tissue mobility

 Use nerve mobilization maneuvers if nerve tension tests are positive.
 Mobilize restricted neurological tissue.
 Joint, muscle and connective tissue mobility

 Use manual and self- stretching techniques to address any mobility
impairments.
 Restricted joint mobility might be present in glenohumeral,
steroclavicular, or first costotransverse articulations. Common muscle
restricted with an impaired postural component include but are not
limited to the scalene, levator scapulae, pectoralis minor and major,
anterior portion of the inter-costals and short suboccipital muscles.
 Therefore tissue specific manual techniques to restricted structures if
tested positive for restricted mobility is done.
 Muscle performance
 Develop control and endurance in postural muscles.
 Common weaknesses include but are not limited to scapular adductors
and upward rotators, shoulder lateral rotators, deep anterior throat
cervical flexor muscles and thoracic extensors.
 Add strengthening and endurance exercises when the symptoms are
not increased with isometric exercises
 Utilize exercises that prepare the patient for a return to functional
activities.
 Progressive resisted exercise with weight belts for shoulder girdle
muscles.
 Respiratory patterns and elevated ribs

 Correction of the faulty breathing patterns.
 Teach abdominodiaphragmatic or bi-basilar breathing patterns.
 Relaxation of upper thorax if the patient tends to use apical breathing
patterns and has increased tension in the scalene muscles.
 Functional independence
 Increase patient awareness and ability to manage symptoms through
education.
 Have patients actively involved in all aspects of their program and the
interventions.
Precautions: Shoulder girdle exercises cause worsening of symptoms in some

patients or they may be progressing favourably, then symptoms worsen.
Worsening of neurological or vascular symptoms may indicate axonal
disruption or vascular compromise. Refer the patient to his or her physician.
Postoperative Physiotherapy Management of TOS
 Routine measures to control pain and inflammation are taken following

surgery.
 Shoulder movements can be initiated after 8-10 days as relaxed passive or
assisted active movements.
 Active mobilization begins after 2 weeks.
 It is intensified gradually along with functional re-education.
 Full function is restarted by 4-6 weeks.
REFERENCE;
 Therapeutic Exercise: Foundations and Techniques: Carolyn Kisner & Lynn Colby
 Essentials Of Orthopedics For Physiotherapists: John Ebnezar

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PHYSICAL THERAPY MANAGEMENT OF THORACIC OUTLET

Thoracic outlet syndrome describes the compression of neurovascular bundle

PHYSICAL THERAPY MANAGEMENT

Non-operative Management of TOS

A program with interventions that specifically address the presenting

 Nerve tissue mobility

 Joint, muscle and connective tissue mobility

 Respiratory patterns and elevated ribs

Precautions: Shoulder girdle exercises cause worsening of symptoms in some

Postoperative Physiotherapy Management of TOS

 Routine measures to control pain and inflammation are taken following

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