Thoracic Outlet Syndrome

Thoracic Outlet Syndrome: Causes, Symptoms, and Chiropractic Solutions

Thoracic Outlet Syndrome (TOS) is a condition caused by compression of the nerves, arteries, or veins in the thoracic outlet, the space between the collarbone and the first rib. This compression can lead to pain, numbness, and weakness in the shoulders, arms, and hands. While conventional treatments include medication and, in severe cases, surgery, chiropractic care offers a non-invasive, drug-free approach that can provide significant relief and long-term recovery.

Understanding Thoracic Outlet Syndrome

TOS occurs when structures in the thoracic outlet become compressed due to:

Poor posture (e.g., forward head posture, rounded shoulders)
Repetitive overhead movements (common in athletes, factory workers, and hairstylists)
Trauma or injury (such as whiplash or fractures)
Congenital abnormalities (e.g., extra rib or tight fibrous bands)

Types of Thoracic Outlet Syndrome

Neurogenic TOS
Caused by compression of the brachial plexus (a network of nerves). This is the most common type.
Venous TOS
Results from compression of the subclavian vein, leading to swelling and discoloration of the arm.
Arterial TOS
Caused by compression of the subclavian artery, which is the least common but potentially the most serious.

Symptoms of Thoracic Outlet Syndrome

Numbness or tingling in the arms or fingers.
Pain in the neck, shoulder, or arm
Weakness or difficulty gripping objects
Swelling or discoloration in the affected limb
Cold sensitivity in the fingers

Scientific Evidence Supporting Chiropractic for TOS

A 2019 study published in the Journal of Manipulative and Physiological Therapeutics found that spinal adjustments significantly improve pain and function in patients with neurogenic TOS.

Research in The Journal of Orthopedic & Sports Physical Therapy suggests that postural correction and manual therapy reduce symptoms in TOS patients without the need for surgery.

A case study in the Annals of Vertebral Subluxation Research (2022) showed remarkable improvement in TOS patients after chiropractic adjustments and myofascial release techniques.

Why Chiropractic Care for
Thoracic Outlet Syndrome?

Chiropractic adjustments can help restore proper alignment, relieve nerve compression, and improve blood flow, addressing the root cause of TOS without drugs or surgery. Here’s why chiropractic care is a top choice for TOS patients:

Poor posture, such as forward head posture or rounded shoulders, can contribute to TOS. Chiropractors use spinal adjustments and posture correction techniques to realign the spine, reducing pressure on the thoracic outlet.

Chiropractic adjustments relieve nerve compression by restoring proper movement in the spine and rib cage, reducing irritation to the brachial plexus.

TOS often limits the range of motion in the shoulders and neck. Chiropractic care includes manual therapy, stretching exercises, and soft tissue techniques to improve mobility.

Chiropractic techniques like trigger point therapy, myofascial release, and instrument-assisted soft tissue mobilization (IASTM) help relax tight muscles and relieve pressure in the thoracic outlet.

Unlike medication, which only provides temporary relief, chiropractic care targets the root cause of TOS, promoting natural healing through spinal adjustments, muscle therapy, and rehabilitation exercises.

How Chiropractors Diagnose Thoracic Outlet Syndrome

Chiropractors use a structured approach when evaluating symptoms that may indicate Thoracic Outlet Syndrome (TOS). TOS diagnosis involves identifying compression of the neurovascular structures between the neck and upper chest, often linked to posture, muscle tightness, or anatomical variations.

Physical Orthopaedic Tests

A series of clinical tests are typically performed to reproduce symptoms or detect vascular and nerve involvement:

• Adson's test

Assesses compression between the scalene muscles and subclavian artery during head rotation and deep inhalation.

• Roos test

Also known as the Elevated Arm Stress Test, it evaluates endurance and symptom reproduction with sustained arm positioning.

• Chronic migraines

Evaluation of cervical spine alignment and muscular tension that may contribute to persistent headaches or migraines.

• Vertigo and dizziness

Assessment of the neck and upper spine for possible mechanical causes influencing balance and orientation.

• Wright's test

Detects neurovascular compression during shoulder abduction and external rotation.

• Costoclavicular manoeuvre

Evaluates space between the clavicle and first rib by positioning the shoulders back and down.

A series of clinical tests are typically performed to reproduce symptoms or detect vascular and nerve involvement:

Postural Assessment

A comprehensive postural exam is conducted to identify contributing factors such as:

Forward head posture
Rounded shoulders

These patterns may increase strain on the thoracic outlet and compress surrounding structures.

Palpation and Motion Testing

Chiropractors manually assess the tension and sensitivity of the scalene muscles and check the mobility of the first rib. These structures are often involved in compressive patterns seen in TOS.

When Imaging is Recommended

If clinical findings are inconclusive or symptoms are persistent, referral for imaging may be considered. This may include:

X-rays to rule out structural abnormalities
Doppler ultrasound to assess vascular involvement
Electromyography (EMG) to evaluate nerve function

This diagnostic process helps determine whether chiropractic care is appropriate or if further medical evaluation is required.

Is Surgery Necessary for Thoracic Outlet Syndrome?

Most cases of Thoracic Outlet Syndrome (TOS) do not require surgery. A structured conservative vs surgical treatment approach is typically followed, depending on the type and severity of the condition.

When Is TOS Surgery Considered?

Surgery is usually reserved for vascular TOS or cases involving a cervical rib.
It may be necessary when blood vessels or nerves are significantly compressed, and symptoms are severe or progressive.
The most common procedure is first rib resection, which involves removing part of the first rib to reduce compression.

Risks of TOS Surgery

As with any invasive procedure, there are potential complications:

Nerve damage
Pneumothorax (collapsed lung)
Scar tissue formation
Post-surgical pain or dysfunction

Conservative Care for Neurogenic TOS

For the more common neurogenic TOS, conservative treatment is usually preferred:

Chiropractic care to improve spinal and postural alignment
Rehabilitation exercises to strengthen and stretch affected muscles
Postural retraining to reduce compression at the thoracic outlet
Manual therapy for soft tissue tension

These approaches aim to relieve symptoms and improve function without the need for TOS surgery.

Conservative Care for Neurogenic TOS

If symptoms persist despite appropriate care, further imaging or specialist referral may be considered to reassess treatment options.

Testimonials

Dilan Jayasinghe

Before I went to Ang Mo Kio TRUE Chiro I'm suffering from Neck problem and back pain. Dr. Justin was very friendly very capable of what he doing. within few sessions my neck was pain free, I feel like it helps to recover my spine. Especial thanks to the staff as well coz the exercises they have recommended me to do help me to recover faster.

Eileen Lee

TRUE Chiropractic has become my weekly ritual. Everyone at the clinic is friendly, professional and super kind. Dr Justin takes time to answer questions, explain stuff I'm not clear about and is very supportive of my recovery efforts. Thanks to them, I'm recovering very well from slipped disc and sciatica without having to go from surgery, and have even been able to resume climbing.

Linda Wong

Had my trial session at the Marine Parade branch on 31 Oct 2023. I was attended to by Dr David Johnson. Dr David is friendly, patient and competent. He listened and understood my issues. After the adjustments. he explained to me the areas of concern.

Frequently Asked
Questions About Thoracic Outlet Syndrome

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