Question
How does thoracic outlet syndrome (TOS) contribute to elbow pain, and what are the best treatment strategies?
Answer
Thoracic Outlet Syndrome (TOS) is a condition in which the brachial plexus and/or vascular structures are compressed between the clavicle and first rib or by tight muscles such as the scalenes and pectoralis minor. This compression can lead to radiating pain, numbness, tingling, and weakness in the upper extremity, often mimicking conditions like cervical radiculopathy or carpal tunnel syndrome. Patients with TOS frequently experience symptoms that worsen with overhead activities, prolonged postures, or repetitive movements involving the shoulder and arm.
A key component of treatment is postural correction, as many individuals with TOS exhibit forward head posture and rounded shoulders. Stretching the scalenes, upper trapezius, and pectoralis minor, along with strengthening scapular stabilizers like the serratus anterior and lower trapezius, can alleviate symptoms. Manual therapy, nerve gliding exercises, and diaphragmatic breathing techniques can further improve neural and vascular mobility. In severe cases, where conservative management fails, surgical intervention to decompress the thoracic outlet may be considered. A comprehensive, multidisciplinary approach ensures the best outcomes for patients with TOS-related elbow pain.
This Ask the Expert is an edited excerpt from the course, "Demystifying Elbow Pain Through Case Studies, Part 2," presented by Rina Pandya, PT, DPT, FHEA, PGLTHE.
