T Nation

Thoracic Outlet Syndrome


Hey folks,

My wife has been in physical therapy for the last few months for pain in her back and neck. She hasn't been responding well to therapy and is now being refered to a thoracic surgeon. Her therapist believes she might have thoracic outlet syndrome.

She's a little freaked out by the prospect of surgery, and I'm not really familiar with the condition or what it entails. Could anyone point me to information on how this condition should be diagnosed and what is typically done for it?



TOS is usually diagnosed by a combination of physical exam and imaging. Surgery can be an option but should be a last option IMO. Ones that I have heard of usually include removing/shaving of the first rib to create more space for the nerves and blood vessels passing through the area.

Questions I have are why did she start to go to the PT in the first place? What did the original doctor diagnose her with? What was she doing with the physical therapist when she initially started going? Did the PT change the treatment after thinking she may have TOS? What made the PT think she has TOS?


It's a clusterf*ck. She started going to the PT on the referal of an ortho who she saw on the referal of a gp. Her complaints were of back pain, mostly around the lower t spine, but sometimes lower, sometimes higher. Frequent headaches and neck pain/stiffness and a loss of strength combined with some pain and numbness in her left arm. She's had these symptoms for quite some time and they seem to be getting worse very slowly.

I'm not sure what specific protocols her PT has carried out, but I know it's involved extensive manual therapy and some corrective exercise. The manual therapy seems to relieve pain in the short term, but she hasn't responded well to exercises at all. I'm not sure how exactly he 'diagnosed' the TOS, but he's essentially stated that there's nothing else he can do to help. We're trying to get her back doc to order an mri before she sees any more specialists so that we actually have something to look at.

Her original doctor didn't realy provide a diagnosis, just a referal generally for back pain. She seems to have a knot very near her spine that is sensitive to pressure. She's had a couple of minor concusions from contact sports, but no specific injuries to the t spine. When she was 19 she went through an exhaustive series of medical evaluations for intense pain in her abdomen, it was never diagnosed and eventually went away, but she seems to feel that it corresponds closely to the location in her back that is painful today.

I wish I had more details, but thanks for the info. I'm hoping that I'll be able to go with her to future appointments over this, she's a bit intimidated sometimes about asking doctors to clarify or explain things.


This post was flagged by the community and is temporarily hidden.