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Thoracic Outlet Syndrome (TOS) is a rare, and often misdiagnosed condition. It occurs when nerves or blood vessels are compressed as they travel from the cervical (neck) region through to the upper arm. This compression can affect nerves from the lower cervical region or brachial plexus, they can also affect the subclavian vascular bundle. Compression in this region leads to discomfort and functional challenges.

Causes of TOS

TOS can stem from various causes, including anatomical variations like an extra cervical rib, poor posture, repetitive overhead activities (common in athletes like swimmers or tradespeople like painters), or trauma such as whiplash. At Spectrum Healthcare North Ryde, we specialise in identifying these triggers to provide targeted care. TOS can masquerade as many different ailments, commonly misdiagnosed as a cervical disc injury or carpal tunnel. Whilst they present similarly, our expert Spectrum staff understand the root cause, which helps to make an accurate diagnosis.

Types of Thoracic Outlet Syndrome

Understanding the type of TOS is essential for effective treatment. At Spectrum Healthcare North Ryde, we classify TOS based on the compressed structure:

• Neurogenic TOS (nTOS): The most common type: caused by brachial plexus nerve compression. It's often linked to repetitive stress, poor posture, or trauma, leading to pain and tingling.
• Venous TOS (vTOS): This involves subclavian vein compression. It may cause swelling or clotting, requiring prompt attention.
• Arterial TOS (aTOS): The rarest: caused by subclavian artery compression, often due to a cervical rib. It can reduce arm blood flow, causing coldness or color changes.

Signs and Symptoms of TOS

TOS symptoms often develop gradually and worsen with specific movements, typically affecting one side (often the dominant arm). At Spectrum, the common signs we see are:

• Pain: Aching or sharp pain in the neck, shoulder, arm or hand; often radiating down the arm.
• Numbness and Tingling: A 'pins and needles' sensation, particularly in the pinky and ring fingers.
• Weakness: Difficulty gripping objects or lifting arms.
• Swelling or Color Changes: In vascular TOS, the arm may swell, turn pale, or feel heavy.
• Other Symptoms: Headaches have been associated with TOS, in particular sub-occipital headaches involving the small muscles at the base of the skull.

Activities like raising arms, carrying heavy bags, or sleeping with arms overhead can worsen symptoms. At Spectrum Healthcare North Ryde, we educate patients on recognising these signs early to prevent escalation.

Imaging

Sometimes, imaging is a useful tool in identifying the cause of a patient's symptoms. Depending on the type of TOS that we suspect, our team at Spectrum may refer for some advanced imaging to determine a cause:

• X-rays: To detect cervical ribs or bone abnormalities.
• Ultrasound: Non-invasive assessment of blood flow for vascular TOS.
• MRI/CT Scans: Detailed imaging of nerves and vessels, sometimes with contrast dye.
• Electromyography (EMG): Measures nerve and muscle function to confirm neurogenic TOS.

How Can Spectrum Healthcare Help You

At Spectrum Healthcare North Ryde, we prioritise non-surgical, conservative treatments to manage TOS effectively, especially when caught early. Our goal is to relieve compression, improve posture, and restore function without invasive procedures. Key approaches include:

• Manual Therapy: Our Sports Chiropractors and Physiotherapists provide customised care focusing on soft tissue release, dry needling, dynamic cupping, joint mobilisations and adjustments. These hands on techniques work together to break down compensation patterns and get you feeling back to normal.
• Targeted Rehab: Our Sports Physio's and Chiro's design bespoke programs to help you address these compensations and improve your function. Best care often encompasses both active and passive care, in other words, hands-on plus at home exercises. For expert advice, seek Spectrum's help.
• Referral: An important part of being an expert clinician at Spectrum Healthcare North Ryde is knowing when to seek further information. In some cases, TOS will require further evaluation, such as imaging as we discussed earlier; or a further opinion from one of our trusted network of sports doctors and physicians.