Thoracic Outlet Syndrome

with Rehab

ExitCare ImageThoracic outlet syndrome is a condition in which nerves, and vessels (less common), are compressed or squeezed in the chest (thoracic) cavity. This results in pain and weakness in the shoulders, arms, and hands.

SYMPTOMS

  • Signs of nerve damage: pain, numbness, and tingling in the arm or hand.

  • Arm and hand weakness.

  • Signs of vascular damage: coldness, inflammation, blue or pale color in the hand and fingers (uncommon).

CAUSES

Thoracic outlet syndrome is caused by the squeezing of nerves, and possibly vessels, in the chest cavity, before they extend into the arm and hand. Just before leaving the chest cavity, the bundle of nerves and vessels (brachial plexus) passes by the collarbone (clavicle) and ribs. In this area, the bundle of nerves can come under increased pressure, which may result in thoracic outlet syndrome. Common sources of pressure include:

  • Rib cage.

  • Fracture of the first rib or clavicle.

  • Neck muscles that are too large.

  • Extending the arm above the head for a long period of time (during sleep or while unconscious)

  • Tumor (rare).

RISK INCREASES WITH:

  • Break (fracture) of the clavicle or first rib.

  • Neck muscles that become too large from bodybuilding.

  • Fast weight loss combined with vigorous physical exercise.

PREVENTION

  • Avoid activities where shoulder or neck injury are likely.

  • Wear properly fitted and padded protective equipment.

  • Maintain good posture.

  • Avoid carrying a bag or backpack that places pressure on the affected side.

  • Change sleeping positions. Try sleeping on one side, or sleep without a firm pillow.

  • Avoid building large neck muscles.

PROGNOSIS

If treated properly, symptoms of thoracic outlet syndrome normally go away with non-surgical treatment. Sometimes, surgery is necessary to free the bundle of nerves from pressure.

RELATED COMPLICATIONS

  • Permanent nerve damage, including pain, numbness, tingling, or weakness.

  • Recurring symptoms that result in an ongoing problem.

  • Clotting (thrombosis) of the axillary vein in the shoulder. This is an emergency that needs to be treated immediately.

  • Risks of surgery: infection, bleeding, nerve damage, or damage to surrounding tissues.

TREATMENT

Treatment first involves resting from activities that aggravate the symptoms, and the use of ice and medicine to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with a therapist. It is important to improve posture and adjust sleeping habits to reduce the symptoms. If symptoms continue for more than 6 months, despite non-surgical treatment, surgery may be recommended.

MEDICATION

  • If pain medicine is necessary, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are necessary. Use only as directed and only as much as you need.

SEEK MEDICAL CARE IF:

  • Treatment does not help, or the condition gets worse.

  • Any medicines produce negative side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the affected arm and hand.

  • Discoloration beneath the fingernails (blue or gray) of the affected hand.

  • Signs of infections: fever, pain, inflammation, redness, or persistent bleeding.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Thoracic Outlet Syndrome

These exercises may help you when beginning to recover from your injury. In order to successfully stop your symptoms, you must improve your posture. These exercises are designed to help reduce the forward-head and rounded-shoulder posture that contributes to this condition. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps return normal motion to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds. Neck muscles are easily irritated, even if they do not seem to be bothered at the time of an exercise. It is often best to begin your stretches with hold times as short as 5 seconds and build up gradually.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETECH - Axial Extension

  • Stand or sit on a firm surface. Assume a good posture: chest up, shoulders drawn back, abdominal (stomach) muscles slightly tense, knees unlocked (if standing), and feet hip width apart.

  • Slowly pull your chin back, so your head slides back and your chin slightly lowers. Continue to look straight ahead.

  • You should feel a gentle stretch in the back of your head. You should be certain not to feel a strong stretch, since this can cause headaches later.

  • Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION- Upper Thoracic Extension

  • Sit on a firm chair with a high back. Assume a good posture: chest up, shoulders drawn back, abdominal muscles slightly tense, and feet hip width apart. Place a small pillow or folded towel in the curve of your lower back, if you are having difficulty maintaining good posture.

  • Gently brace your neck with your hands, allowing your arms to rest on your chest.

  • Continue to support your neck and slowly extend your back over the chair. You will feel a stretch across your upper back.

  • Hold __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Mid-thoracic Extension

  • Tape two tennis balls together, or secure them side-by-side in a sock.

  • Find a firm surface to lie on. Position the tennis balls so that one lies on each side of your spine, and they are both between your shoulder blades. You may bend your knees if you choose.

  • Remain in this position for 20 to 30 seconds. Gently move your body 1 to 2 inches up (in the direction of your head), so that the balls now roll on a slightly lower part of your back. Hold this position another 20-30 seconds. Continue to move the balls down your spine until you no longer feel a stretching sensation.

Repeat exercise __________ times, __________ times per day.

STRENGTHENING EXERCISES - Thoracic Outlet Syndrome

These exercises may help you when beginning to recover from your injury. In order to successfully stop your symptoms, you must improve your posture. These exercises are designed to help reduce the forward-head and rounded-shoulder posture that contributes to this condition. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make sure you are following the directions exactly. If the pain is still present after adjustments, stop the exercise until you can discuss the trouble with your caretaker.

ExitCare Image STRENGTH - Scapular Retractors

  • Secure a rubber exercise band or tubing around a fixed object (i.e. table, pole), so that it is at the height of your shoulders when you are either standing, or sitting on a firm, armless chair.

  • With a palm-down grip, grasp an end of the band in each hand. Straighten your elbows out and lift your hands straight in front of you at shoulder height. Step back, away from the secured end of the band, until it becomes tense.

  • Squeezing your shoulder blades together, draw your elbows back as you bend them. Keep your upper arm lifted up, away from the sides of your body, throughout the exercise.

  • Hold __________ seconds. Slowly ease the tension on the band as you reverse the directions and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

POSTURE - Thoracic Outlet Syndrome

Keeping correct posture when sitting, standing or completing your activities will reduce the stress put on different body tissues. This will allow injured tissues a chance to heal and limit painful experiences. The following are general guidelines for improved posture. Your physician or physical therapist will provide you with any instructions specific to your needs. While reading these guidelines, remember:

  • The exercises prescribed by your caregiver will help you develop the flexibility and strength to maintain correct postures.

  • Correct posture provides the best environment for your joints to work. All your joints have less wear and tear when properly supported by a spine with good posture. This means you will experience a healthier, less painful body.

  • Correct posture must be practiced with all of your activities, especially prolonged sitting and standing. Correct posture is as important during repetitive, low-stress activities (i.e. typing) as it is when doing a single, heavy-load activity (i.e. lifting).

ExitCare Image PROLONGED STANDING WHILE SLIGHTLY LEANING FORWARD

When completing a task that requires you to lean forward, while standing in one place for a long time, place one foot up on a stationary 2 - 4 inch high object, to help maintain the best posture. When both feet are on the ground, the low back tends to lose its slight inward curve. If this curve flattens (or becomes too large), then the back and your other joints will experience too much stress, tire more quickly, and can cause pain.

ExitCare Image PROLONGED ACTIVITY IN A FLEXED POSITION

When completing a task that requires you to bend forward at your waist or lean over a low surface, find a way to stabilize 3 out of 4 of your limbs. You can place a hand or elbow on your thigh or rest a knee on the surface you are reaching across. This will provide you more stability so that your muscles do not tire as quickly. By keeping your knees relaxed, or slightly bent, you will also reduce stress across your low back.

ExitCare Image WALKING

Walk with an upright posture. Your ears, shoulders and hips should all line up.

OFFICE WORK

When working at a desk, create an environment that supports good, upright posture. Without extra support, muscles tire, leading to too much strain on joints and other tissues.

ExitCare Image CHAIR:

  • A chair should be able to slide under your desk when your back makes contact with the back of the chair. This allows you to work closely.

  • The chair's height should allow your eyes to be level with the upper part of your monitor and your hands to be slightly lower than your elbows.

BODY POSITION

  • Your feet should make contact with the floor. If this is not possible, use a footrest.

  • Keep your ears aligned over your shoulders. This will reduce stress on your neck and low back.