Thoracic Outlet Syndrome (TOS) may sound complicated, but at its core, it’s about pressure in the wrong place. The thoracic outlet is the small space between your collarbone and first rib. Important nerves and blood vessels pass through it on their way to your arm. If that space becomes crowded—because of poor posture, tight muscles, or even an extra rib—it can cause a variety of symptoms in the arm, shoulder, or hand.
Types of TOS
Neurogenic TOS (most common): Compression of nerves. Symptoms include numbness, tingling, weakness, or pain down the arm and into the hand.
Venous TOS: Compression of veins. Symptoms include arm swelling, heaviness, or bluish discoloration.
Arterial TOS (least common but most serious): Compression of arteries. Symptoms include coldness, pale skin, or weak pulse in the arm.
How is TOS Treated?
Most people start with conservative (non-surgical) treatment, and the good news is that physical therapy is usually very effective.
Posture training: Learning to sit and stand tall takes pressure off the thoracic outlet.
Stretching and strengthening: Specific exercises lengthen tight muscles and build support in the shoulders and upper back.
Activity modification: Avoiding prolonged overhead movements and adjusting workstations can help.
Pain relief: Ice, heat, and anti-inflammatory strategies may reduce irritation.
If symptoms are severe or involve serious blood flow problems, surgery may be needed, but most cases improve with consistent therapy.
Physical Therapy Exercises for TOS
Here are a few simple exercises often recommended for people with thoracic outlet syndrome. Always check with a physical therapist before starting to make sure these are right for you.
Scalene Stretch
Sit or stand tall.
Tilt your head to one side, bringing your ear toward your shoulder.
Hold 20–30 seconds, then repeat on the other side.
Helps release tight neck muscles that can crowd the thoracic outlet.
Pectoralis Stretch (Doorway Stretch)
Stand in a doorway with your arms on each side, elbows bent at 90°.
Gently lean forward until you feel a stretch across your chest.
Hold 20–30 seconds.
This opens up the chest and reduces pressure on nerves and vessels.
Shoulder Blade Squeeze (Scapular Retraction)
Sit or stand with arms relaxed at your sides.
Gently pull your shoulder blades back and down (as if tucking them into your back pockets).
Hold for 5 seconds, repeat 10–15 times.
Builds postural strength and stability.
First Rib Mobilization (with a strap or towel)
Place a strap or towel over the top of your shoulder, holding the ends down in front.
Gently pull down on the strap while tilting your head slightly away.
Hold 15–20 seconds.
Helps reduce tension on the first rib, where compression often occurs.
Nerve Glides (Median Nerve)
Extend your arm out to the side with the palm facing up.
Slowly straighten the elbow and extend the wrist and fingers, as if pushing away.
Then relax. Repeat 5–10 times.
Encourages nerve mobility without overstretching.
Thoracic Outlet Syndrome can be frustrating, but the right approach makes a big difference. Physical therapy is often the key, helping you improve posture, mobility, and strength to take pressure off sensitive nerves and vessels. With consistent stretching, strengthening, and lifestyle adjustments, many people find lasting relief. If you have questions about how to treat your Thoracic Outlet Syndrome, contact our office at 480-785-5415.