May 18, 2022

Thoracic Outlet Syndrome

Will Ireland

Thoracic Outlet Syndrome & Massage

What is it?

Thoracic Outlet Syndrome is a condition were the nerves between the lower neck and the armpit are compressed, causing pain, numbness, and/or tingling down the arm and in the fingers. Pain can be persistent or intermittent, and can be sharp, burning, or aching. In the hands, TOS can affect just the pinky finger, or can cover the entire hand. There may also be pain on the side of the neck, the pectoral area below the clavicle, the underarm, and the upper back between the shoulder blades. Loss of circulation in the arms can also cause a bluish discoloration of the skin in the hands


What causes it?

  • Certain body types, or certain skeletal morphologies from birth, can lead one to be more susceptible to developing TOS. The most common is the presence of a cervical rib, an abnormally large transverse processes of the spine. In addition,  different neck muscle morphologies and connective tissue abnormalities could potentially lead to TOS. Children born with a cervical rib can start developing symptoms of TOS when they hit adolescence and develop more muscle.


  • Trauma to the neck, such as whiplash, or a repetitive strain injury
    • Athletes such as baseball players and pitchers are particularly susceptible


  • Kyphosis, or a forward head posture, and put cause tightness in the anterior muscles of the neck and upper torso


  • Rarely can be caused by certain tumors


What relieves it?

A TOS pathology is often caused by overly tight muscles that surround the brachial nerves and arteries leading from the neck to the arm. Therefore, released tension in those muscles can restore function of the nerves and blood flow to the arm. Here are the most likely muscles that are causing the constriction:

  • Anterior scalenes
  • Pectoralis minor
  • Subscapularis
  • Teres major


Massage and TOS

Massage therapies for TOS focus on relieving any tension of the muscles that are causing the compression, while also allowing the nerves and veins to slide into the spaces they were designed to flow through. This can be achieved through passive range of motion of the shoulder joint and of the neck.

Various tests can be performed to find where exactly the compression lies. These involve checking for a radial pulse while the client performs various movements with the shoulder and arms

Release of the Pectoralis minor muscle can make a big difference in relieving the compression of the nerves and arteries that travel underneath the muscle itself. In addition to Pectoralis minor, linking up trigger points on the medial edge of the scapula and Teres major can relieve a lot of the “forward roll” tightness in the shoulder, and bring it back to a healthy postural setpoint.

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