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  • Eric Lau

Thoracic Outlet Syndrome: Early Signs, Treatment, and Exercises

Are you having numbness and tingling in your hands? Are your hands feeling swollen and cold? Often this condition is misdiagnosed as carpel tunnel syndrome which is a compression of a nerve in the wrist. The true cause of this condition is often caused by compression of a group of nerves in the neck and is called thoracic outlet syndrome. Proper diagnosis of this condition is important for treatment and to prevent re-injury. Let’s find out more about thoracic outlet syndrome.



What is it?


Thoracic outlet syndrome is caused when a group of nerves and blood vessels are compressed in a space between the collar bone and first rib. Thoracic outlet syndrome can be caused by:

-Poor posture and ergonomics.

-Truama from a collision in sport or motor vehicle accident.

-Anatomical anomaly such as having an extra rib.

-Pregnancy.


What are the signs and symptoms?


-Pain, numbness, tingling in the arm, forearm, hand. Symptoms can be in all or one of these areas.

-Swelling and discolouration in the hand.

-Weaking arm or grip strength.

-Cold hands.

How is it treated?


With thoracic outlet syndrome the brachial plexus can be compressed at the scalene muscles, pectoralis minor muscles, or by the 1st rib. The scalene muscles are muscles along the side of the neck. Massaging and stretching these muscles can relieve the pressure it is applying on the brachial plexus. Tension along the pectoralis minor muscle which is a muscle along the front of the chest can also compress on the nerves. Massage, active release, and electro acupuncture is particularly effective at releasing the pectoralis minor. Finally if the first rib is elevated it can also apply pressure upward onto the brachial plexus. Your physiotherapist will stretch the 1st rib downward by performing a treatment called joint mobilization. Your physiotherapist will apply an oscillating downward pressure along the rib to relieve its pressure on the nerves.


Common Home Exercises

Scalene stretch


Side bend your head to your opposite shoulder. Apply a bit of over pressure with your hand. Hold this stretch for 20-30 seconds and repeat for 3 sets.

Rebuild physiotherapist stretching scalene muscles

Pec minor release


The pec minor is located along the outer edge of the chest just as it connects to your shoulder. Place the lacrosse ball in this area. Gently massage this area by leaning your body weight into the ball.


Inferior first rib stretch


Use a waist belt for this exercise. Place the belt over the affected shoulder and hold either end with your hands. Look toward your arm pit on the affected side. Take a deep breath in and as your breathe out pull downward to glide the first rib inferiorly. Repeat 10 repetition and 3 sets.

Physiotherapist using a waist belt to stretch his first rib

Median nerve floss


Start with your arm straight resting by your side and bend the wrist back so your palm is facing the floor. Bend your head to the opposite arm you would like to stretch. To perform the exercise lift your arm up and side bend your head toward your arm.


click below for picture of median nerve floss exercise:

https://www.rebuildphysiotherapy.com/post/carpal-tunnel-syndrome-early-signs-treatments-and-exercises

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