Thoracic outlet syndrome

Thoracic outlet syndrome (TOS) is the compression of neurovascular structures as they exit the thorax (cervicobrachial region). Exit from the thorax is characterised by the скалените at the front, скалените at the rear and the lowest rib.

Researchers have identified three main categories of TOS – venous, arterial and neurogenic.

Congenital factors:

  • Cervical rib
  • Prolonged transverse growth on the vertebrae
  • Anomalous muscles
  • Fibrous anomalies (transverse costal, costochondral)
  • Anomalies of insertion of
  • Fibrous muscle fibre
  • Exostosis of the lower rib
  • Cervicodorsal scoliosis
  • Congenital uni- or bilateral raised scapula
  • Location of subclavian artery and vein in relation to outer мускули скалени

Postural factors:

  • Slack shoulder
  • Incorrect working posture (standing straight or seated, with no attention paid to physiological curse of the spinal column)
  • Heavy mammary glands
  • Trauma
  • Collar bone fracture
  • Rib fracture
  • Neck hyperextension, whiplash
  • Repetitive stress-related injuries (repetitive injuries most often occur by sitting in front of a computer for a prolonged period of time)

Muscular causes:

  • Hypertrophy of мускули скалени
  • Reduction in tone of M. trapezius, M. levator scapulae, M.rhomboids
  • Tearing of мускули скалени, M. trapezius, M. levator scapulae, thorax muscles


  • Pain, paraesthesia, tingling and/or weakness
  • Cervicogenic headache
  • Symptoms during the day and night
  • Loss of fine movements and controls
  • Inability to withstand the cold (possibly due to Raynaud’s disease)
  • Objective weakness

Physiotherapy identifies the main cause of the problem and helps in selecting the right treatment methods. The treatment used depends largely on issues identified during your first consultation.