Neurogenic Thoracic Outlet Syndrome: Symptoms, Causes, Treatments

neurogenic-thoracic-outlet-syndrome-symptoms-causes-treatments

Do you experience neck, arm and hand pain if you've been sleeping or doing a task with your arm raised above your head? Does your hand sometimes tingle,  go numb, or swell up if you've had your hand above your head for a while? You may have thoracic outlet syndrome.

There are 3 types of thoracic outlet syndrome:

  1. Neurogenic Thoracic Outlet Syndrome - where symptoms are related to nerve compression,
  2. Venous Thoracic Outlet Syndrome - where symptoms are related to compression of veins (blood vessels taking blood back to the heart), and
  3. Arterial Thoracic Outlet Syndrome - where symptoms are related to compression of arteries (blood vessels taking blood from the heart out to the body).

This blog will be focusing on the symptoms, causes and treatment of neurogenic thoracic outlet syndrome (TOS).

What is Neurogenic Thoracic Outlet Syndrome?

A diagnosis of Neurogenic Thoracic Outlet Syndrome refers to pain and other nerve symptoms in the neck, arm and hand, related to compression of nerves as they run from the neck down into the arm (read more about symptoms below).

Where does compression of the nerves occur in neurogenic thoracic outlet syndrome?

Compression of the nerves coming from the neck may occur in 3 main locations on their pathway to the arm and hand:

  1. Between the scalene muscles at the side of the neck,
  2. As the nerves run under the collar bone and over the 1st rib, or
  3. As the nerves run under the pectoralis minor muscle in the chest.
what-is-neurogenic-thoracic-outlet-syndrome
what-is-neurogenic-thoracic-outlet-syndrome

Find our physio clinic in Brisbane Tarragindi

Our Brisbane Physiotherapy Clinic, services areas including: Brisbane, Tarragindi, Mount Gravatt, Holland Park, Rocklea, Yeronga, Annerley, Camp Hill, Carindale, Coorparoo, Salisbury, Sunnybank, Greenslopes, Seven Hills, Acacia Ridge, Indooroopilly, Woolloongabba, etc.

Because of our expertise in hip conditions, dance injuries and performance, and hypermobility, we also have people visiting us from all over Queensland, Australia and even international visitors. We also have a telehealth service for remote patients.

Do you have neck, shoulder or arm pain? Do you wake up with pain and tingling or numbness down your arm or in your hand, if you've been sleeping with your arm over your head? Not sure if you have Neurogenic Thoracic Outlet Syndrome?

Book in with one of our friendly and experienced physios, and let us help correctly diagnose your pain, and help get you moving again.

Symptoms of Neurogenic Thoracic Outlet Syndrome

There are a number of symptoms experienced with Neurogenic Thoracic Outlet Syndrome, which include:

  • Pain in the neck, shoulder and arm - sometimes all the way to the hand
  • Pain associated with sustained positioning or movement of the arm overhead or behind the body (think pec stretch)
  • Numbness in the shoulder, arm or hand
  • Pins and needles or tingling in the shoulder, arm or hand
  • Odd sensations in the neck, shoulder, arm or hand 
  • Muscle weakness in the neck, shoulder, arm or hand
  • Sleep disturbance
symptoms-of-neurogenic-thoracic-outlet-syndrome
symptoms-of-neurogenic-thoracic-outlet-syndrome

Causes of Neurogenic Thoracic Outlet Syndrome:

Neurogenic thoracic outlet syndrome has a number of potential causes, including anatomical, postural, occupational or recreational factors. For some people there may have also been a traumatic event that started the problem.

Thoracic outlet syndrome is also more common in females and those aged between 30 and 50 years of age.

Anatomical Causes of Neurogenic Thoracic Outlet Syndrome

Anatomical variations or tightnesses that may increase the risk of developing TOS include:

  • an accessory rib - an extra rib that sits above the first rib, increasing compression as the nerve winds up and over this additional rib
  • tightness of the scalene muscles of the neck - increasing possibility of compression as the nerves run between this muscles as they exit the neck
  • tightness of the pectoralis muscles - increasing possibility of compression as the nerves run under this muscle as they exit the chest and enter the axilla (underarm) on the way to the arm. 

Postural Causes of Neurogenic Thoracic Outlet Syndrome

The positioning of the neck and shoulders can impact on the relative muscle tightness and space available in the 3 potential areas of compression (see What is Thoracic Outlet Syndrome image above).

Positions that may increase the risk of nerve compression include:

  • a forward head posture, and
  • downward sloping and forward tilting of the shoulders (shoulders sitting forward and down).

Note that not everyone who sits with such postures will develop this condition. It is more likely in such postures are sustained for extended periods over multiple days of the week. This can lead to shortening of the musculature in the neck and front of the chest and shoulders, resulting in depressing (lowering) of the shoulder and collarbone.

Over time, this positioning can decrease the amount of space available for the neurological structures to pass through ultimately leading to compression of the nerves travelling under the collar bone and under-arm into the upper limb. The condition is also more likely to arise when combined with other risk factors. 

Occupational Causes of Neurogenic Thoracic Outlet Syndrome

Occupational causes usually relate to either sustained positioning in the postures discussed above and/or sustained or repetitive use of the arms overhead.

Occupations most likely to develop this condition:

  • Desk-based jobs, particularly computer based work,
  • Overhead occupations e.g., electricians, mechanics, plasterers, painters.
  • Musicians e.g., violonists, flautists

Recreational or Sporting Causes of Neurogenic Thoracic Outlet Syndrome

Thoracic Outlet Syndrome in athletes is most common in overhead athletes, primarily throwing athletes - e.g., softball, baseball, javelin.

The development of TOS in athletes is usually related to a combination of factors that may include:

  • excessive, repetitive strain,
  • poor conditioning,
  • high work-to-rest ratios (lots of training and not enough recovery time),
  • long-term playing time
  • inadequate efficiency or coordination of the shoulder and scapular (shoulder blade) muscles
  • hypermobility (often linked with inadequate control, particularly in younger athletes)
  • predisposing postures as mentioned above
  • predisposing muscle tightnesses as mentioned above
  • predisposing anatomical variations, like an extra rib.

Other causes of shoulder and arm pain

Alternatively, there are other conditions that can exhibit similar symptoms to nTOS, such as cervical radiculopathy (irritation of the nerve roots as they leave the spine) or even shoulder tendinopathy or bursitis. For more information, refer to our Shoulder Conditions page.

A comprehensive physiotherapy assessment to help distinguish the underlying cause of the condition is important for choosing the desired treatment plan.

causes-of-neurogenic-thoracic-outlet-syndrome
causes-of-neurogenic-thoracic-outlet-syndrome

Experiencing muscle weakness, or pins and needles, in your arm or hand?

Book today, and let one of our Brisbane Physios help diagnose your pain correctly, and get you back to doing the things you love!

Treatments for Neurogenic Thoracic Outlet Syndrome

Physiotherapy management as a first treatment is most often recommended by health care professionals. For most people, physiotherapy will be able to provide a successful outcome. In some cases, imaging such as MRI or Xray may be required, after which surgical intervention may be warranted for the more severe cases.

At PhysioTec, we are able to offer rehabilitation for those suffering from Neurogenic Thoracic Outlet Syndrome.

This would involve the following:

  1. A thorough assessment by one of our experienced PhysioTec Physios, to determine the correct diagnosis and likely contributors to the problem (this can be different for different people). 
  2. The development of a targeted exercise protocol aimed to reduce nerve compression and pain, and improve function.
  3. Hands-on treatment - massage to muscles, joint mobilisations and gentle nerve mobilisation techniques.
  4. Taping may sometimes be helpful in the shorter term to support and train shoulder positioning.

Exercises can involve scapular positioning, strengthening of thoracic and shoulder musculature, stretching of shortened anterior muscles and nerve-sliding exercises as well.

treatments-for-neurogenic-thoracic-outlet-syndrome
treatments-for-neurogenic-thoracic-outlet-syndrome

Is pain in your shoulder, arm, or neck making it hard to move normally, work, or do regular activities? Visit us at PhysioTec, and let one of our physios provide an assessment and a personalised program to help you get on-top of your pain, and back to those favourite activities!

↓ MAKE A BOOKING TODAY ↓

Tyler Cultum - Physio at Physiotec, Tarragindi, Brisbane

Author

This blog was written by Tyler Cultum, one of our Sports and Strength & Conditioning Physiotherapists. He has broad interests in sports and musculoskeletal physiotherapy, with special interests in strength and conditioning, the shoulder and hip. You can read more about Tyler here.

Blogs by Tyler

AWESOME BLOGS THAT TYLER HAS CONTRIBUTED TO PROUDLY!
neurogenic-thoracic-outlet-syndrome-symptoms-causes-treatments

Neurogenic Thoracic Outlet Syndrome: Symptoms, Causes, Treatments

By Tyler Cultum | 2 April 2024

Do you experience neck, arm and hand pain if you’ve been sleeping or doing a task with your arm raised above your head? Does your hand sometimes tingle,  go numb, or swell up if you’ve had your hand above your head for a while? You may have thoracic outlet syndrome. There are 3 types of…

Importance-of-a-well-balanced-strength-program-for-throwing-athletes

Importance of a well-balanced strength program for throwing athletes

By Tyler Cultum | 5 July 2023

The shoulder is a complex and beautiful joint in the human body. For the same reasons of being a beautifully functioning articulation, we are faced with added challenges such as stability. Having a such a vast range of motion, the shoulder is able to move in all movement planes, leading to an increased demand for…

pain-in-the-kneecaps-causes-signs-and-treatment

Pain in the kneecaps: causes, signs and treatment

By Tyler Cultum | 7 February 2023

Allow me to introduce myself. I’m Ty, a sports physiotherapist at PhysioTec, recently recovered from my own pain in the kneecaps. I’m thirty-five years old, I’m six feet, four inches tall and I weigh roughly two hundred twenty-five pounds. I enjoy training for and competing in triathlons and have since learned that I qualify for…

Swimmer’s Shoulder: For the Novice Triathlete

Swimmer’s Shoulder: For the Novice Triathlete

By Tyler Cultum | 4 July 2022

As a Canadian living in Australia, I was immediately enamoured with the Triathlon culture. The climate here affords us such great opportunity to be outdoors running, cycling, swimming and much more. Just reminding myself to use sunscreen more than back in cold Canada. Having had no proper training in cycling or swimming and only moderate…

Shoulder or arm pain can have a large impact on your life, limiting your movement, and keeping you away from doing the things you love. At PhysioTec, our experienced physios can assess you and provide you with a personalised program to help you get on-top of your pain, and back to doing the things you love!

If you would like to book with one of our experienced Brisbane Physios, please call, email or book online below:

Phone: (07) 3342 4284

Email: reception@physiotec.com.au