My Personal Experience with Thoracic Outlet Syndrome

Before downloading the TOS handout (below), I'd like to share my venous TOS story with you. 
It was a typical September morning in 2011 when I woke up with my right arm swollen and painful. I was in the first semester of Physical Therapy school, and fortunately made the decision to go to my general practitioner's office rather than attend my morning classes. At the doctor's office,  the nurse practitioner recommended I go immediately to the emergency room due to the amount of swelling and bluish hue of my right arm. The imaging quickly revealed a four-inch blood clot in my subclavian vein. I was referred to a vascular specialist who diagnosed me with right Venous Thoracic Outlet Syndrome (vTOS).
 I was a healthy, young 21 year old, who had a 4 inch blood clot in a major vein. "How does this happen!" I thought to myself.
The vascular surgeon told me that surgery was the necessary solution to my vTOS. In November 2011, ​I underwent an 11-hour surgery which entailed a first rib resection and removing muscles in my upper shoulder region. Since the surgery, I have recovered remarkably well. I can do almost all activities at the same level of intensity. I am grateful for the full recovery because many people continue to have problems post-surgery. I credit my success to a positive, goal-oriented mindset and a diligent focus on the rehab exercises and recovery. During my surgical recovery, I fully believed I would get better after the surgery, and I took action steps to make that happen! It was both mindset and action that made me successful.

Handout Contents

  • Thoracic Outlet Syndrome explained
  • Week-by-week post-surgery program
  • FAQ for pre- and post- surgical clients
  • General healing time frames​
  • Exercise advice and recommendations
  • Anti-coagulation therapy
  • Scar tissue management
  • Using compression garments

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Learn More about TOS Pain, Symptoms, and Treatment from Dr. Jim Heafner

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What is Thoracic Outlet Syndrome​ (TOS)?

Thoracic Outlet Syndrome is a condition that occurs in a wide variety of individuals without a single specific known cause. TOS commonly occurs in young, healthy athletic people who use their arm overhead repeatedly in their sport. While it frequently impacts working adults, the cause of the diagnosis is often unknown. TOS is hard to diagnosis because the origin of symptoms occurs in several different locations.

The 3 most common regions that are involved:

  1. Between the first rib and collarbone 
  2. Between the anterior and middle scalene muscles 
  3. Underneath the pectoralis minor muscles
The thoracic outlet is the region of the body between the neck and shoulder. For various reasons, if this space becomes narrowed over time, the subclavian vein (vTOS), subclavian artery (aTOS), or one of the nerves (nTOS) can become pinched and scarred. For example, pitchers and overhead athletes are at risk for TOS because of repetitive overhead motions. The symptoms each person will experience is mostly determined by the structure that is receiving too much compression or tension.
What are the Symptoms?
The symptoms each person will experience is mostly determined by the structure that is receiving too much compression or tension. In venous TOS the space between the first rib and collar bone is often narrowed. One reason this can occur is due to overdeveloped scalene muscles, which pull the first rib upward and decrease the space available for the vein. In turn slows the flow of blood through the subclavian vein, which narrows and scars the vein over time. Blood clots in the subclavian vein generally form after a period of intense activity and may take place years after the compression first begins. Fortunately, venous TOS only impacts ~5-10% of all TOS diagnosis'. Ninety percent of people have neurogenic TOS (Alla et. al. 2010). 
Treatment Options
Treatment for TOS has changed considerably over the years. Individuals with neurogenic TOS are almost always treated with a conservative plan of care. This includes physical therapy, muscle relaxants, anti-inflammatory agents, and workplace ergonomic changes. While conservative management is ideal, some individuals with chronic nTOS and nearly all individuals with aTOS and vTOS require surgical interventions.
TOS Exercises
Open Book Exercise
middle back flexibility with pec muscle stretch
Shoulder Blade T's
middle trapezius strengthening
Forearm Plank Presses
serratus anterior and core strengthening
Want More Exercises?
take the TOS online program
TOS Education