In addition an upper chest breathing pattern will tend to pull the first rib upwards, further reducing the size of the thoracic outlet, with the potential to cause TOS. When the shoulders and clavicle pulled forward and down for prolonged periods, this may result in a reduced space in the thoracic outlet. The result of this imbalance (or perhaps the cause of it) is poor posture.
The opposing muscles are usually weak (rhomboid major and minor and trapezius). These include the scalenus anterior and medius and the pectoralis major and minor and the subclavius. Muscle imbalances occur when particular muscles may become short and tight due to overuse of poor posture. Muscle imbalances, posture, breathing and TOS Physiotherapy plays a vital role in this form of the condition. Muscle imbalances can also alter the position of both the first rib and the clavicle contributing to nerve compression, pain and numbness in the arm. Excessive tension or hypertrophy of the adjacent muscles may cause direct compression. In some cases it requires surgery.įunctional Thoracic Outlet Syndrome (also known as Physiological Thoracic Outlet Syndrome) is very common condition in which prolonged postures (such as sitting at a computer with shoulders hunched forwards and down) may result in compression of the nerves of the brachial plexus. Investigations such as a CT scan or MRI can help with diagnosis. Physiotherapy may still be indicated, however consultation with a specialist medical practitioner may be advisable. This may be due to an abnormality present from birth, such as an extra rib attaching to the lower cervical spine or may be the consequence of injury. Structural Thoracic Outlet Syndrome is a rare condition, which involves bony restriction of the space through which the nerves and blood vessels pass. Symptoms are often aggravated by overhead activities (such as hanging out washing or sleeping with the arm overhead) put traction on the brachial plexus. Sometimes TOS may affect the whole hand, arm, neck and even the side of the face. The ulnar nerve is the most commonly compressed and this supplies the inside of the elbow, the little finger and the ring finger so symptoms are often felt but not confined to these area.
Symptoms of TOS may include arm numbness, pain, pins and needles, coldness or heaviness of the arm. In Thoracic Outlet Syndrome, the brachial plexus (a bundle of nerves) and far less often, the subclavian nerve or artery can become compressed by surrounding structures.
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