Thoracic Outlet Syndrome: My Best Tips As a Physical Therapist

You may think you have thoraco-brachial outlet syndrome (also known as thoracic outlet syndrome), or have you actually been diagnosed with it?

Find the answers to the questions patients most frequently ask physiotherapists about this pathology!

♻️ Last update: March 15, 2025
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of financial interests is available in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

How can you be sure it’s thoracic outlet syndrome?

📌 The first step in diagnosing this syndrome is to ask questions and examine yourself.

During this clinical examination, your doctor or physiotherapist may perform a few manual tests:

• Adson test: palpation of the pulse in a specific position;
• Roos test: open/close hands with arms raised.

Your healthcare professional will also ask you about your symptoms. The following are typical of thoracic outlet syndrome:

• diffuse pain in the neck, shoulder or arm,
• numbness, tingling,
• muscle weakness,
• or circulatory problems (swelling, change in arm color).

📌 Based on this initial workup, if your doctor has any doubts about the pathology that may be causing your symptoms, he or she may prescribe additional tests that will serve to:

• eliminate other diseases that could be the cause of the syndrome;
• determine the precise origin of the syndrome: what is causing the nerve or vascular compression.

These additional examinations are :

• imaging : an X-ray can detect bone anomalies, such as a rib fracture. Ultrasound, MRI or angiography can analyze blood vessels if compression is suspected;
• an electromyogram (EMG): to test how your nerves function.

What’s behind it?

Thoracic outlet syndrome occurs when the nerves, veins or arteries passing between the clavicle, first rib and scalene muscles (= neck muscles) are compressed.

Here are the main causes, which can be identified or assumed through clinical examination or complementary tests:

• anatomical: presence of an extra cervical rib, muscular anomalies, tumours ;
• trauma: collarbone fractures, car accidents, whiplash ;
• posture & repetitive movements: rolled shoulders, prolonged work with raised arms, sports that put a lot of strain on the shoulders (swimming, baseball, tennis);
• unbalanced musculature: a weak trapezius can cause the shoulder to collapse and increase compression.

In a nutshell: thoracic outlet syndrome can be caused by structural anomalies, trauma or repetitive postures.

Is it possible to be disabled or off work because of this syndrome?

Yes, in some cases, thoracic outlet syndrome (TOS) can lead to a temporary work stoppage, especially if the pain is severe or the symptoms limit the use of the arm.

📌 Cases most concerned:

• Work requiring repetitive movements or prolonged raising of arms (e.g. hairdressers, painters, musicians).
• Persistent pain and numbness, preventing daily movements.
• Serious complications such as venous thrombosis (phlebitis).

Permanent disability is rare, as most patients improve with appropriate treatment.

However, if symptoms become too disabling despite treatment, recognition as a long-term condition (ALD) or adaptation of the workstation may be considered.

Are physiotherapy sessions useful for thoraco-brachial outlet syndrome?

Yes, physiotherapy is the main treatment recommended to relieve symptoms and prevent the syndrome from worsening.

🎯 Here are the session objectives:

• identify everyday actions at work and at home that aggravate symptoms and consider alternatives to gradually eliminate syndromes: adapting actions, using adapted equipment, better dosage of activity, etc;
• temporary relief of symptoms, if requested: massage, stretching, TENS, application of heat, etc;
• strengthen chest and shoulder muscles to support nerve and vascular structures, stretch zone muscles to limit muscular tension.

Your physiotherapist will begin by carrying out an assessment , which will enable him/her to review with you what goals are achievable, what you prioritize and what bothers you most.

Can I do exercises at home?

You can do exercises at home if you have identified that it is beneficial for you.

Physiotherapy sessions are relatively short and infrequent: if you incorporate things into your routine on your own, there’s a better chance of seeing a favourable change in your symptoms quickly 💪 !

Here are the 2 main types of exercise often recommended for thoracic outlet syndrome.

• Gentle neck and shoulderstretches to release tension.
• Targeted muscle strengthening to stabilize the chest area.

Sometimes, your physiotherapist won’t suggest any specific exercises, because he or she feels that what you really need is a better dose of pain-triggering activities, or more physical activity in general, without necessarily doing any specific exercises.

Is a cure possible?

As physiotherapists, we regularly see people who have been diagnosed with thoracic outlet syndrome become completely pain-free after a few weeks or months.

In a recent academic publication, the authors report (without source) a cure rate of 9 out of 10 patients undergoing physiotherapy for thoraco-brachial outlet (Kaplan 2023).

When the pain lasts for months, when there is a real hindrance to daily activities and no hint of a favorable evolution, surgery is sometimes proposed.

It involves decompression of the brachial plexus, the set of nerves that run between the neck and the shoulder.

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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!