Dr. Vaishali Suri (P.T.)
Thoracic Outlet Syndrome: Physiotherapy Treatment in Faridabad
Thoracic outlet syndrome (TOS) is caused by compression of the neurovascular structures (brachial plexus, subclavian artery or vein) in the space between the collarbone and first rib. It is frequently misdiagnosed — presenting as neck, shoulder, or arm pain with neurological symptoms that can mimic cervical disc disease, carpal tunnel syndrome, or rotator cuff pathology.
Physiotherapy is the primary treatment for neurogenic TOS (the most common form).
At Realign Rehab Clinic, NIT-5, Faridabad, our expert physiotherapists provide personalised, evidence-based care. Serving NIT, Green Field Colony, Ballabhgarh, Sector 21–82, and across Faridabad. Contact us: +91 9818185589.
Research Insight: A 2021 systematic review in Physiotherapy confirmed that structured physiotherapy targeting posture correction, scalene stretching, and neural mobilisation resolves symptoms in 70–80% of neurogenic TOS cases, with outcomes equivalent to surgical first rib resection for mild-to-moderate cases.
Causes and Risk Factors
- Poor posture: rounded shoulders narrowing the thoracic outlet space
- Hypertrophy or tightness of the scalene and pectoralis minor muscles compressing neural structures
- Cervical rib (anatomical variant): extra rib from C7 creating additional compression
- Overhead work and repetitive shoulder elevation narrowing the costoclavicular space
- Whiplash injury causing scalene spasm
- First rib elevation from chronic upper trapezius tension
- Carrying heavy bags on one shoulder chronically
Signs and Symptoms
- Aching, heaviness, or pain in the arm, shoulder, and neck
- Numbness and tingling in the hand and fingers (often ulnar distribution)
- Symptoms worsened by overhead activities, driving, or carrying bags
- Cold hand or arm (vascular TOS — less common)
- Weakness of the intrinsic hand muscles in chronic cases
- Positive Roos test: arms raised to 90° and opening and closing the hands reproduces symptoms
TOS is one of the most underdiagnosed causes of arm symptoms. The combination of arm pain, tingling, and neck pain makes clinicians think of the cervical spine.
But if the cervical imaging is normal and the MRI doesn't explain the symptoms, TOS should be high on the differential. A few specific clinical tests quickly point to the correct diagnosis.
- ✦ Neurogenic TOS accounts for 95% of TOS cases; vascular TOS is rare
- ✦ TOS is most common in women aged 20–40 and in overhead athletes
- ✦ Physiotherapy resolves symptoms in 70–80% of neurogenic TOS cases
- ✦ Cervical rib is present in 0.5–1% of the population and increases TOS risk
Physiotherapy Treatment at Realign Rehab, Faridabad
- Scalene and pectoralis minor stretching and soft tissue release
- First rib mobilisation to increase the costoclavicular space
- Postural correction: shoulder retraction and depression, thoracic extension
- Thoracic outlet decompression exercises: specific shoulder girdle movements
- Neural mobilisation: brachial plexus mobilisation techniques
- Deep cervical flexor and scapular stabiliser strengthening
- Ergonomic assessment: workstation setup, bag carrying habits, sleeping position
- Breathing retraining: diaphragmatic breathing to reduce scalene overactivity
Recovery Programme
Phase 1 — Pain Relief (Weeks 1–3): Manual therapy, electrotherapy, and gentle movement to reduce inflammation and restore baseline function.
Phase 2 — Strengthening (Weeks 3–8): Progressive resistance training, neuromuscular re-education, and functional retraining.
Phase 3 — Return to Activity (Weeks 8–16): Task-specific conditioning and a home programme to maintain gains and prevent recurrence.
Why Choose Realign Rehab Clinic, Faridabad?
Led by Dr. Vaishali Suri (BPT), Realign Rehab delivers one-on-one physiotherapy with advanced electrotherapy, manual therapy, and home visits.
Our clinic is at NIT-5, Faridabad — accessible from Green Field Colony, Sector 21–82, Ballabhgarh, and the Delhi border.
- Personalised treatment plans based on your specific diagnosis
- Evidence-based protocols aligned with international guidelines
- Home visits for post-operative and mobility-limited patients
- Flexible appointments: Mon–Sat, 9 AM – 7 PM
Frequently Asked Questions
What is thoracic outlet syndrome?
TOS is compression of the nerves (brachial plexus) and blood vessels (subclavian artery/vein) between the collarbone and first rib, causing arm pain, tingling, and weakness. Neurogenic TOS (nerve compression) is the most common type.
How is TOS diagnosed?
Clinical diagnosis is based on symptoms and specific provocative tests (Roos test, EAST test, Adson's test). Imaging (MRI, Doppler ultrasound) confirms vascular involvement.
A physiotherapy assessment can identify TOS and rule out cervical disc disease.
Can physiotherapy cure thoracic outlet syndrome?
In 70–80% of neurogenic TOS cases, physiotherapy completely resolves symptoms. Surgery (first rib resection) is reserved for severe cases or those failing 3–6 months of physiotherapy.
How long does TOS physiotherapy take?
A structured physiotherapy programme runs 8–12 weeks. Initial improvement is usually seen within 3–4 weeks of postural correction and stretching. Full resolution may take 3–6 months.
What aggravates thoracic outlet syndrome?
Overhead activities, carrying heavy bags, sustained computer work with rounded shoulders, and sleeping with the arm raised are the most common aggravators. Activity modification is a key part of physiotherapy management.
Book Your Consultation
Contact Realign Rehab Clinic today:
- 📍 NIT-5, Faridabad (near Green Field Colony, Ballabhgarh Road)
- 📞 +91 9818185589
- 🕑 Mon–Sat: 9 AM – 7 PM