Thoracic Outlet Compression Syndrome
Thoracic outlet compression syndrome (TOCS) is a condition affecting the area between the collarbone and the first rib, a space called the thoracic outlet. It entails compression of the nerves or blood vessels in the thoracic outlet, just under your clavicle, or collarbone, where nerves and blood vessels travel from your chest to your arm.
When TOCS involves compression or entrapment of blood vessels, it can cause diminished blood flow to the shoulder, arms and hands, resulting in swelling tingling, coldness and weakness. Nerve entrapment most commonly affects the brachial plexus, a group of nerves that exit the spinal cord in the neck and travel through the thoracic outlet and down the arm. The brachial plexus nerves control the muscles of the shoulder, elbow, wrist and hand, and provide feeling in the arm.
While relatively uncommon in the general population, TOCS is more common among athletes, especially those playing sports that require repetitive arm and shoulder movements, like baseball, tennis, swimming, volleyball and golf. Middle aged women are also more prone to TOCS, generally due to poor posture and underdeveloped muscles.
Other causes of TOCS include:
  • Sleep disorders
  • Tumors or enlarged lymph nodes in areas of the upper chest and underarm
  • Stress
  • Injury from carrying heavy loads
  • Whiplash or other trauma
  • Inefficient posture
  • Weightlifting and activities that create enlarged muscles
Because TOCS often affects the nerves, it can impair movement from the neck and shoulder, all the way to the fingers.

Diagnosis of TOCS

TOCS is difficult to diagnose because a number of other conditions can cause similar symptoms. To get an accurate diagnosis, a thorough patient history and review of symptoms will be conducted.
Common symptoms of TOCS include:
  • Pain in the neck, shoulder and arm
  • Weakness, coldness and/or numbness in the fingers
  • Reduced sensation of touch
  • Swelling in the arms
  • Ache in the side and back of the head that extends to the chest area
  • Reduced function of the shoulder, arm and hand
In neurogenic TOCS, different symptoms can present, depending on the location of nerve compression:
  • Compression of the upper brachial plexus may cause symptoms in the side of the head and neck, including the ear, jaw, face, temple and back of the head. Upper plexus compression may affect the forearm and arm, but not the hand.
  • Lower plexus compression tends to affect the arm and hand. You may experience some numbness or tingling in the ring and little fingers.
Ultrasound provides a reliable means of diagnosing TOCS when combined with testing and patient history. Tests include assessments of muscle strength and arm sensation, with the arm held in neutral positions and in positions where the patient experiences maximal symptoms.

Treatment for TOCS

Physical therapy is the most effective way to resolve TOCS. Your therapist is likely to take a multi-modal approach to treatment, including:
  • Strengthening exercises for the muscles that support the collarbone
  • Exercises and training to correct postural issues, to reduce pressure on the nerves and blood vessels
  • Lifestyle modification, including weight loss, workplace ergonomics and increased physical activity
  • Sport-specific rehab training for athletes
In rare cases, surgery may be required to reduce compression. Surgical interventions sometimes involve the removal of a rib or releasing the scalene muscles that join the neck and head.

TOCS Treatment at NYDNRehab

The physical therapy team at NYDNRehab takes a holistic whole-body approach to diagnosis and treatment. We understand that your symptoms are unique to you and your lifestyle, and we treat every patient on a case-to-case basis. At NYDNRehab, we use cutting-edge technologies and advanced treatment methods to get to the source of your pain and resolve it. If you are experiencing symptoms of TOCS, contact NYDNRehab for a quick and accurate diagnosis, and an individualized treatment plan.
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