Thoracic Outlet Syndrome

People come to physical therapy for many different reasons. One of the most common reasons people come to physical therapy is because of pain. People rarely know why they are having pain; they just know something hurts and they want it to feel better. Physical therapists see people with pain in many different areas of their body, but a common complaint is arm pain which may also involve numbness or tingling. These are often non-specific complaints that can come from many different places, so a priority in physical therapy is to determine where the pain is coming from so we can direct our treatment to the right part of the body.

Arm pain with numbness can come from structures in the neck, the shoulder, the elbow, and the hand or wrist, so it can be complicated to figure out. It can even be more complicated if it involves many of these areas at the same time. One example of this is a condition called thoracic outlet syndrome. This syndrome involves compression of nerves as they travel from the neck into the arm. A physical therapist evaluates each of these areas to determine where the compression may be coming from and directs treatment to the appropriate places.

There are three primary locations that are evaluated as part of an assessment for thoracic outlet syndrome. These areas of compression can include the muscles along the side of your neck called the scalenes which can compress the nerves as they leave the neck area, the space between the clavicle (or collarbone) and the 1st rib where the nerves travel toward the arm, and in the chest where one of your pectoral muscles (pectoralis minor) can compress these nerves as make their way into the arm. Evaluation of these areas in combination with assessment of the neck, shoulder, elbow, and hand is important to make sure the treatment is directed to the appropriate structures where the compression is occurring.

Conservative care including physical therapy is often the best choice for treatment of thoracic outlet syndrome. Treatment approaches can include soft tissue stretching and manual techniques to improve soft tissue mobility, nerve gliding to improve mobility of the nerves in the areas of compression, and postural training and strengthening to ensure the structures do not continue to compress the nerves. The physical therapist determines the best approach and which structures need to be addressed, but physical therapy is a great place to start anytime you have unusual pain or numbness in your arm because it might just be thoracic outlet syndrome.


By Ken Johnson, PT, DPT – South Emerson


About Ken:

I became a PT because I was involved in a lot of high school athletics & worked with our school athletic trainer quite a bit. He got me interested in the sports medicine side of athletics.  The favorite part of my job is working with motivated, active people who want to get back to their activities – work, home, or athletic.  A fun fact about myself is I started cycling ten years ago for exercise and fitness.