I have a client who suffers from Thoracic Outlet Syndrome in her right arm, and I am looking for exercises that might help.
Thank you for your question. Thoracic Outlet Syndrome (TOS) is a condition usually associated with neuropathies (nerve injuries). There have been no reports of specific sports that cause TOS, but it should be clearly stated that any upper extremity activity can reproduce TOS symptoms. These symptoms include upper limb pain, tingling of the hand, loss of grip strength and loss of associative limb muscle strength. This condition is largely overdiagnosed due to the controversial nature of evaluation techniques. But regardless of the clinical evaluation, the person presenting with TOS will have very similar dysfunctions.
Common causes of TOS are poor posture, extended periods of sitting, upper rossed syndrome, tightness and shortening of anterior thorax muscles (pectoralis major and minor) and weakness and lengthening of posterior thorax scapular stabilizers (rhomboids, lower trapezius). Hypertrophy of the scalenes can produce a pinching of nerve tissues (causing pain) under the clavicle (collar bone). Also involved are weak neck flexors and tight neck extensors. Tightness in the anterior thorax in relation to weakness in the posterior thorax combined with poor posture will cause a change in the way the shoulder joint is positioned on the body. Over time, this bad alignment changes the way the muscles work together to produce movement. Some muscles are too long, while others are too short. This is not an optimum alignment of the shoulder and will produce very predictable symptoms. Remember that tight and weakened muscles alter the length/tension relationship, which alters the force/couple relationship, which produces poor posture and poor movement patterns. Ultimately, an injury is produced. The good news is, the symptoms of TOS are often correctable with exercise.
Generally speaking, you will want to concentrate on improved flexibility to the anterior muscles combined with strengthening of the posterior muscles, especially those that stabilize the scapula. Also, your client will need postural work. By improving total body flexibility, core strength and balance, your client’s symptoms should subside. However, if pain persists, refer your client to a physician for further diagnostic evaluation and treatment protocols.
Recommended Corrective Exercises and Stretches (from PTN Exercise Library):
- Aptaker RL: Neck pain: Part 1: Narrowing the differential. Phys Sports Med. 24(10). Oct 1996
- Reeves RK, Laskowski ER, Smith J: Weight triaining injuries: Part 2: Diagnosing and managing chronic conditions. Phys Sports Med. 26(3). Mar 1998