Physical Therapy and Thoracic Outlet Syndrome

By definition thoracic outlet syndrome is a compression of the thoracic outlet which is a space in the front of the neck where nerves, arteries, and veins pass through on their way down the arm and to the fingers. The thoracic outlet is bordered by the T1 thoracic vertebrae in the back, the first rib, as well as the anterior scalene muscle in the front.

Patients that have thoracic outlet will have a variety of symptoms depending on if the artery, nerve, or vein (or all) are being compressed. Some of the problems range from neck pain, arm/hand pain numbness and tingling, bluish color or reddish color of the fingers or hands, coldness of the hand, swelling of the arm/hand, arm/hand weakness, and overall upper body dysfunction. These symptoms may or may not appear in conjunction with neck disorders as well.

There are many causes of thoracic outlet syndrome ranging from an extra first rib in the neck, postural problems, neck trauma, repetitive activity, and even pregnancy. Physical therapy treatment will focus on neck motion, stretching of the neck musculature, posture re-education, manual mobilization of neck structures /joints, nerve stretching, and strength of the postural muscles.

In the event that conservative therapy does not resolve the symptoms, there are surgical procedures such as a first rib removal and/or a release and resection of the anterior scalene muscle that can help the symptoms. Seeing a surgeon that specializes in thoracic outlet is the key.

Mizuta & Associates specializes in all types of thoracic outlet syndrome including neurogenic, vascular, and arterial. If you are experiencing any neck/upper arm symptoms that are keeping you from your daily life, call to schedule an evaluation. We work closely with surgeons in San Diego that also specialize in thoracic outlet if a consult is needed.