Thoracic Outlet Syndrome and Manual Osteopathy

Written by Katolen Yardley, DO (EU), MNIMN, RH (AHG)

Manual osteopathy can support the bodies homeostasis by addressing its structure and alignment; thereby enhancing optimal function. Through enhancing the function of underlying anatomical structures, including circulation, lymphatic vessels and nervous system, there is also stimulation of the routes responsible for transporting nourishment to the body’s cells and for facilitating waste removal out of cells.

Thoracic outlet syndrome (TOS) is a condition leading to a combination of symptoms including: pain, weakness, numbness, tingling, a cold sensation, a limb that tires quickly or, sometimes, a more general type of discomfort in one or both upper limbs.

Thoracic outlet syndrome refers to a group of disorders related to the compression of blood vessels or nerves located in the area above and behind the clavicle (collarbone) from the neck to first rib.

The term “thoracic outlet” refers to its location in the body – namely the space between the clavicle to the first rib, over to the shoulder forms an “outlet” through which blood vessels and nerves pass before they enter the arms to supply them with circulation (blood and oxygen) and sensation (pain and feeling) .

Types of thoracic outlet syndrome?

  1. More specifically, vascular thoracic outlet syndrome relates to compression of arteries and/or veins.
  2. Comparatively, when there is a narrowing of the thoracic outlet space compressing the nerves between the clavicle and chest wall, or where nerves and vessels pass under muscles as they cross the shoulder; this is known as the brachial plexus also called “neurogenic thoracic outlet syndrome“.
  3. Or there can be a presentation of a combination of the two.

Most common Thoracic Outlet Syndrome

The most common types of thoracic outlet syndrome is characterized by compression of the brachial plexus. The brachial plexus is a network of nerves running from the spinal cord and controls muscle movements and sensation in ones shoulder, arm and hand.

Causes of Thoracic Outlet Syndrome

Common causes of thoracic outlet syndrome include:

  • Physical trauma from a car accident and/ or whipash.
  • Bodybuilding resulting in overdeveloped muscles of the neck thereby compressing nerves and the subclavian vessels.
  • Repetitive injuries from job- or working with your arms overhead such as painters, hair stylists, auto mechanics.
  • Sports-related activities, including swimming or baseball.
  • Certain anatomical defects such as having an extra first rib or abnormal development of the scalene muscle.
  • Hypermobility of either of the glenohumeral joint of the shoulder or the scapula can create tension on the nerves or blood vessels in the thoracic outlet region.
  • Poor posture and weight gain.
  • Pregnancy.
  • Sometimes the cause of thoracic outlet syndrome is unknown.

Symptoms of Thoracic Outlet Syndrome

Health issues present uniquely to each individual, however in terms of thoracic outlet syndrome;

  • Pinched nerves could lead to chronic pain radiating down the arm; numbness and tingling;
  • Over the long term there could be possible muscle atrophy in a limb,
  • Decreased range of motion,
  • Loss of mobility and loss of function.
  • There may be decreased sensation in the arm, or possibly even the development of raynaud’s syndrome (chronically cold hands and fingers) and perhaps even the development of carpal tunnel syndrome.

Development of Thoracic Outlet

In the occurrence of Thoracic Outlet Syndrome, an initial injury or trauma could result in positional changes of bone alignment leading to development of scar tissue of surrounding tissues; this could potentially lead to a narrowing in the space of the brachial plexus or shoulder girdle with pressure and impingement on underlying nerves and decreased blood flow.

This paints the picture of an initial injury and how changes in scapula position, or overdeveloped muscles could impact the function of the arm muscles and nerves radiating to the fingers, contributing to tingling and numbness.

Manual Osteopathy and Thoracic Outlet Syndrome

Thoracic Outlet Syndrome
  • A manual osteopathic practitioner follows the path of the lesion, assessing and ensuring the proper alignment of fascia, bones and connective tissue above arteries and nerves, alleviating any restrictions while focusing on the area of the shoulder girdle and neck, decompressing nerve fibres, reducing pain and trigger points while maintaining range of motion to the shoulder and neck.

Gentle repetitive movements are used to stimulate all tissue in a localised area including the fascia, ligaments, joints, tendons, bones as well as stimulate underlying tissues to remove congestion, stagnation, improve blood flow and ensure unimpeded flow of fluids and nerve impulses.

Non Surgical Treatment options

  • A manual osteopath can assist with improving your posture, by suggesting ergonomic modifications and providing by postural exercises including a focus on:
    • Strengthening the rhomboids and trapezius muscles that retract the shoulders.
    • Improving head and neck alignment.
    • Stretching the pectorals muscles of the frontal chest wall.
  • Stretching can includes hunching the shoulders anteriorly (forward) – holding for a count of 10- moving the shoulders back to a neutral position – holding- then extending them posteriorly (backward), then back to neutral – holding. This is followed by lifting the shoulders up as high as possible (so shoulders to ears), and then back down to neutral, repeated in 4 cycles.
  • Tilting and extending the neck opposite to the side of the injury while keeping the injured arm is kept down or wrapped around the back.
  • Chin retractions and doorway stretches are also helpful. One home exercise can be performed by placing the entire forearm (from wrist to elbow) upward at 90 degrees positioned on both sides of a doorway. Then, you slowly lean forward until a stretch is felt in the front of the shoulder joint. Hold this position for 20 to 30 seconds. Note: Any home exercise that causes pain or triggers symptoms should be discontinued; instead consult your manual osteopath.
  • Addressing mechanical symptoms with the right combinations of exercise, stretching, strengthening and along with modifications of activities offers a first-line approach. Often this can address the symptoms so a client can avoid surgery.

Manual osteopathic therapy is the perfect adjunct to the internal use of Phytotherapy (aka herbal medicine) and vice versa, allowing options for client centered health care which offers support both internally and somatically (via gentle hands on treatment).

While an Osteopathic wellness program is never a one program fits all scenario; manual osteopathic therapy seeks to treat the individual, thus treatment is also tailored to the individual.

To find out is Osteopathic manual therapies are right for you, or to set up your appointment today in our Vancouver or Port Moody office, email our office at: