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Looking for thoracic outlet syndrome treatment?  Apex Manual Therapy can help! 


Our advanced physical therapists have obtained the highest level of orthopedic physical therapy training and are recognized as Fellows of the American Academy of Orthopedic Manual Physical Therapy, (FAAOMPT). This educational achievement is beyond the doctorate level and guarantees the gold standard care for thoracic outlet syndrome symptoms.  


At Apex Manual Therapy each visit is spent entirely one-on-one with a Fellow to provide the very best treatment for your muscle strain recovery. 

If you’re in the Greater Austin or Pflugerville, TX, area schedule a free consultation with our advanced physical therapists.   

We guarantee you’ll see the difference in our approach and your results. 


What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome (sometimes referred to thoracic syndrome) is compression of the brachial plexus. To better understand how this compression can occur, a quick anatomy lesson is helpful.

The brachial plexus is made of the C5, C6, C7, C8 and T1 nerve roots. These nerve roots exit through small holes known as interverbal foramen. The intervertebral foramen is where the two spinal vertebrae meet.  

The photo below on the right shows the placement. The vertebrae are stacked on top of one another, and between the vertebrae the cervical (neck) nerves exit. These nerves travel and tunnel between muscles and bones all the way down to the fingertips.  


















After the nerve roots exit the cervical vertebrae, they travel between the anterior and medial scalene muscles, over the 1st rib, under the clavicle (collar bone), under the pectoralis minor muscle and in front of the humerus (upper arm bone).  




Vascular Thoracic Outlet Syndrome

Vascular thoracic outlet syndrome means the vascular system (arteries) is under compression instead of the nerves. When the nerves are the compressing structure, it is referred to as neurological thoracic outlet syndrome. 

Vascular Thoracic Outlet Syndrome Symptoms: 

  • Decreased radial pulse

  • Cold

  • Entire arm is numb

  • Arm weakness 

  • Heavy sensation in the arm



Neurological Thoracic Outlet Syndrome Symptoms:

  • Numbness 

  • Tingling

  • Weakness

  • Changes in sensation

  • Pain


Thoracic Outlet Syndrome Causes

Thoracic outlet syndrome causes can include anything which compresses the nerves or arteries. Some of the most common causes are: 

Movement dysfunctions of the neck or shoulder are the number one thoracic outlet syndrome cause.  Movement dysfunctions occur from sustained posture, repetitive movements or compensations due to prior injuries because the body adapts to the demands placed on it. Everyone, unless they’ve worked with a movement specialist (Physical Therapist), develops movement dysfunctions. This is the reason we all have different postures and movements. Some common movement dysfunctions which contribute to thoracic outlet syndrome are: 

  • Scapular depression syndrome

  • Humeral anterior glide syndrome

  • Cervical extension syndrome

  • Cervical extension rotation syndrome

  • Scapular internal rotation syndrome

Presence of a cervical rib. This is a genetic defect that causes one to be born with an extra rib. If you’ve developed thoracic outlet syndrome symptoms later in life yet you’ve had this cervical rib since birth, then it can’t be the cervical rib responsible for the thoracic outlet syndrome symptoms. Further evaluation is needed to identify the cause. 

Elevated first rib. This occurs from poor shoulder and neck mechanics causing the first rib to rise. You must learn how to move correctly to avoid the rib from rising up and compressing the nerves and/or arteries.

Thoracic Outlet Syndrome Treatment

Diagnosing someone with thoracic outlet syndrome is often referred to as a trash can diagnosis because it is often too vague and doesn’t report anything on why it occurred. This diagnosis would hold the same weight as giving someone a diagnosis of neck pain. It tells you nothing about the cause, the problem, or what treatment is needed.  

A more detailed diagnosis is required before thoracic outlet syndrome treatment can begin. A physical therapist must identify why the nerves or arteries are being compressed. Physical therapists are the thoracic outlet syndrome specialist who will provide you with a thorough diagnosis and customize a thoracic outlet treatment program.   

As you might have already realized, one thoracic outlet syndrome treatment is correcting the faulty movements that occur at the neck and shoulder. However, thoracic outlet syndrome exercises must be tailored to each individual’s specific movement dysfunction.

Thoracic Outlet Syndrome Surgery

It is very rare that someone needs thoracic outlet syndrome surgery. Thoracic outlet syndrome surgery is for those who may have developed a tumor, abnormal growth or anatomical changes that are causing compressing against the nerves or arteries.  

An evaluation with a physical therapist can help determine if a surgical consult is needed. Thoracic outlet syndrome surgery recovery time and rehabilitation would be dependent on the surgery performed.  


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