March 2022

Thoracic Outlet Syndrome
By Dr. Cal Lisman

        The Thoracic Outlet is a space between the collar bone and the first rib in which the

nerves and arteries associated with the cervical spine pass into the upper extremity. This space

can become encroached upon causing Thoracic Outlet Syndrome, commonly referred to as TOS.  TOS can be caused by poor posture, repetitive motions with work or recreational activities (especially those involving heavy weight), anatomical defects or trauma.

This syndrome is commonly sustained in individuals who utilize many overhead motions. TOS

commonly presents in individuals ages 20-50, but can occur at any age. Females are three times

more likely to suffer from this condition.



        TOS can cause symptoms both in the neck and upper extremities.  The most common are as follows:

  • Neck, shoulder or arm pain
  • Numbness and tingling in the arm, hand and/or fingers
  • Fatigue of affected side with activity
  • Weakened grip strength 

       Some less common symptoms include:

  • Weak pulse ·     
  • Pale appearance of the hand or fingers
  • Abnormally cold hand or fingers 
  • Extremely rare, but most severely can present with blood clotting in the arm·       

TOS cases that are due to trauma or anatomic abnormalities may require surgery to reduce symptoms.  More often than not, TOS will be non-traumatic and related to repetitive overuse.  Conservative treatment can include:

  • Active Release Techniques cleans up the scar tissue adhesions that build up in soft tissue structures
  • Chiropractic manipulation to help release joint restrictions
  • Rehabilitative exercise to strengthen and stabilize the surrounding muscles
  • Load management to prevent reoccurrence

Active Performance Chiropractic focuses on the diagnosis, treatment, and rehabilitation of athletic-related injuries.  Treatment is a unique blend of Active Release Techniques®, traditional chiropractic therapy, and physical rehabilitation designed to match each patient’s goals and lifestyle.