What is Thoracic Outlet Syndrome (TOS)?

by Son PMR(Physical medicine & Rehabilitation ) & Chiropractic Clinic in Seoul

Thoracic Outlet Syndrome (TOS) is a condition caused by the compression of nerves or blood vessels in the thoracic outlet—the space between the clavicle (collarbone) and the first rib. This area is a narrow passage through which vital neurovascular structures pass from the neck to the arm.

In most cases, the brachial plexus, subclavian artery, or subclavian vein are compressed, leading to symptoms such as numbness or tingling in the arms and hands, vascular insufficiency, or muscle weakness.

🔍 Causes

1. Anatomical Factors

  • Presence of a cervical rib

  • Narrowing of the space between the clavicle and first rib

2. Muscular Factors

  • Hypertonicity of the scalene muscles, which compress the brachial plexus

  • Tightness of the pectoralis minor muscle

3. Postural / Functional Factors

  • Poor posture such as forward head, rounded shoulders, or text neck

  • Repetitive arm use or trauma that alters the alignment of the cervical-thoracic region

⚠️ Symptoms

1. Neurogenic TOS (Most Common)

  • Numbness and tingling in the arm and fingers (especially the 4th and 5th digits)

  • Symptoms worsen when lifting the arm overhead

  • In advanced cases: muscle atrophy in the hand

2. Vascular TOS

  • Venous compression: arm swelling, bluish discoloration

  • Arterial compression: pale, cold hands with weak or absent pulse

💡 Treatment

TOS is a multifactorial condition. Therefore, a comprehensive and conservative (non-surgical) treatment approach that addresses structural, muscular, and neural components is often highly effective.

✅ 1. Upper Cervical Correction

  • Misalignment of C1 and C2 can trigger muscular imbalance and sympathetic nervous system overactivity

  • Evaluation using CBCT and Prone Leg Check

  • Gentle and precise corrections using Thumb Technique or Toggle Recoil

Benefits:

  • Relaxes neck and shoulder muscles

  • Reduces nerve compression

  • Improves blood flow and autonomic balance

✅ 2. Chiropractic Adjustments

Target areas:

  • First rib, cervico-thoracic junction (C7–T1)

  • Clavicle and scapula

Goals:

  • Restore alignment and motion in the C-T junction, critical for postural and neurological balance

  • Normalize motion of the first rib, which plays a key role in thoracic outlet space

  • Adjust the clavicle and scapula to open the neurovascular pathways

✅ 3. IMS (Intramuscular Stimulation) Therapy

Target muscles:

  • Anterior and middle scalene muscles

  • Pectoralis minor, trapezius, levator scapulae

Benefits:

  • Directly releases overactive muscles

  • Reduces pressure on nerves

  • Eases pain, tightness, and numbness

✅ 4. Nerve Block & Perineural Injection

  • Nerve Block: Stabilizes hypersensitive nerves (e.g., brachial plexus), reducing pain and abnormal sensations

  • Perineural Injection: A targeted injection around the nerve to

    • Release adhesions

    • Calm nerve irritation

    • Secure the space along the nerve pathway using local anesthetics

✳️ These two procedures complement each other, especially for chronic nerve-related symptoms.

✅ 5. Scalene Muscle Release

As a key compression site in TOS, treating the scalene muscles is crucial for long-term symptom relief.

Methods:

  • IMS injection into the scalene muscles to release internal tension

  • Myofascial Release Therapy to ease surrounding tissue restrictions and improve circulation

  • Scalene stretching exercises to maintain flexibility and prevent recurrence

🧾 Treatment Summary

Treatment ElementDescription
Upper Cervical CorrectionRestore alignment of C1–C2, balance autonomic tone
Chiropractic CareMobilize C7–T1, first rib, clavicle, and scapula to widen thoracic outlet
IMS InjectionsRelease tight muscles (scalenes, pectoralis minor, levator scapulae)
Nerve Block + Perineural InjectionReduce nerve hypersensitivity, release adhesions
Scalene Muscle ReleaseIMS + myofascial release + stretching for sustained improvement

🔚 Conclusion

Thoracic Outlet Syndrome is rarely caused by a single structural issue. It usually involves a combination of cervical misalignment, muscle tension, nerve irritation, and vascular restriction.

By combining:

  • Upper cervical and chiropractic adjustments for alignment and mobility

  • IMS and myofascial techniques for muscular decompression

  • Nerve block and perineural injection for neural regulation

you can achieve meaningful, non-surgical symptom relief and restore both comfort and function to daily life.

👍Consultation and Appointment Information

Son PMR & Chiropractic Clinic( 2nd floor, 229-1 Gucheonmyun-Ro, Gangdongu, Seoul, South Korea) 

by  Dr Son MD & DC 
Contact: 02-482-8875 in Seoul( +82-2-482-8875)

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