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 Medical Massage & Rehabilitation

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome is a condition that involves the compression of the neurovascular bundle (brachial plexus ( C5-T1) and its accompanying artery and vein).

  1. Anterior Scalene Syndrome – TOS in the Anterior and middle scalene
  2. Pectoralis Minor Syndrome – TOS beneath the pectoralis minor muscle
  3. Costoclavicular Syndrome – TOS between the clavicle and the first rib

Massage Treatment:

  • Hydro:
    • deep moist heat to Hypertonic muscles, cool hydro to edematous tissue
  • Prone:
    • Basic Massage Techniques to the upper back
    • Deep muscle stripping on Trapezius
    • Ischemic Compressions and Muscle Stripping to Trigger points that refer to the medial hand
  • Supine:
    • Myofascial Release to the neck, shoulder, chest.
    • Sternocleidomastoid treatment before treating scalenes
    • Origin and Insertion, Muscle Stripping, Petrissage, Ischemic Compressions on the Scalenes
    • Myofascial Release, Muscle Stripping, Petrissage, GTO on Pectoralis Major, then Pectoralis minor muscles
    • Muscle strippin on the Subclavius muscle
  • Sidelying:
    • Myofascial release and petrissage to the to the neck, shoulders, latissimusdorsi
    • Petrissage to pectoralis major and minor

By using Neuromuscular Therapy or Trigger Point Therapy myofascial trigger points in the scalene muscles and other muscles of the front of the neck this can be eliminated.Myofascial Release techniques or Deep Tissue Massage techniquesrelease fascial adhesions in the area of the thoracic outlet and surrounding tissues, and help them to release.Muscle Energy Techniques can lengthen the scalene muscles and other affected neck, chest and shoulder muscles.

Considerations / Contraindications:

  • Deep moist heat over the heart
  • Deep moist heat in the anterior neck if client has hypertension or atherosclerosis in the neck
  • Frictions with anti inflammatories
  • Deep Muscle Stripping on atrophied muscles
  • Avoid aggressive mobilization technique if client has a cervical rib, Rheumatoid Arthritis , or Degenerative Disc Disorder in the cervical spine

Signs and Symptoms

  • Numbness and tingling in fingers and hand
  • Pallor, Purple or bluish fingertips
  • Venous compromise ( ischemia and edema in hand)
  • Not seen with anterior scalene syndrome
  • Neuronal compression:
  • Paresthesia and hyperthesia ( numbness and tingling ) primarily on ulnar side and can spread to entire hand
  • Pain ( diffuse, aching, throbbing) in the shoulder, forearm , hand
  • Pain triggered or increased by letting the arm hang
  • Motor Weakness or atrophy of the hypothenar muscle


  • Stretch the muscles of the neck (Sternocleidomastoids, scalenes, pectoralis)
  • Strengthen muscles of the upper back and neck with exercise and stretching (upper trapezius, rhomboids)

References and Credits

Smythe WR, Reznik SI, Putnam Jr. JB. Lung (including pulmonary embolism and thoracic outlet syndrome). In: Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 59.