Amanpreet Kaur

By - Amanpreet Kaur
Functional Manual Therapist at VARDĀN
Thoracic outlet syndrome (TOS) is a condition in which there is compression of the nerves, arteries, or veins in the passageway from the lower neck to the armpit. There are three main types: neurogenic, venous, and arterial. The neurogenic type is the most common. Patients also complain of headache which may be due to posture, tension or vascular compromise.
Risk Factors
  • Pregnancy.
  • Females>Males.
  • Young adults, 20-40 years old.
  • Congenital abnormalities - Cervical rib, prolonged transverse process.
  • Poor posture - Drooping shoulders and positioning the head forward can cause compression in the thoracic outlet area.
  • Postural stress, such as carrying a heavy bag, can place stress on shoulder girdle, creating traction on the artery, vein, nerve.
  • Respiratory patients- lack of use of diaphragm leads to excessive use of scalene muscles leading to compromised space.
  • Repetitive activity or vigorous occupation - increases muscle bulk and thereby decreases outlet space.
  • Hypertrophy and scarring of muscles like pectoralis major and minor(chest muscles).
  • Fracture: malunion of the clavicle can sometimes compress NV bundle.
  • Secondary to conditions like frozen shoulder.
  • Trauma (e.g. whiplash injuries).
  • Rarer acquired causes include tumors (especially pancoast tumor).

Neurogenic Thoracic Outlet Syndrome
Neurogenic TOS includes disorders produced by compression of components of the brachial plexus nerves. The neurogenic form of TOS accounts for 95% of all cases of TOS.

  • Pain or weakness in the shoulder and arm.
  • Tingling or discomfort in the fingers.
  • Parasthesias.
  • Arm that tires quickly.
  • Atrophy — shrinking and weakness — of the pad of the thumb, the muscle of the palm that leads to the thumb; this is quite rare.
  • Symptoms made worse when arms are held up.
Arterial Thoracic Outlet Syndrome
Arterial TOS is due to compression of the subclavian artery. This is less than 1% of cases.

  • Sudden painful Edema (swelling) of the arm, hand or fingers.
  • Blueness of the hand and arm.
  • Painful tingling in the hand and arm.
  • Very prominent veins in the shoulder, neck, and hand.
Venous Thoracic Outlet Syndrome
Venous TOS is due to compression of the subclavian vein. This makes up about 4% of cases.

  • Rare - causes are usually cervical rib.
  • Cold and pale hand.
  • Pain in the hand and arm, especially during overhead motions of the arm.
  • Arm fatigues easily.
  • Throbbing lump near collarbone.
  • Physical therapy is typically the first treatment.
  • Botulinum toxin injections are sometimes effective when physical therapy doesn’t completely relieve symptoms.
  • If symptoms persist after physical therapy and injections, surgery may be recommended. Surgery involve removing the cervical or first rib.
How FMTTM helps?
Functional Manual Therapy® (FMTTM) is an integrated evaluation and treatment system that promotes optimum human performance by enhancing total body mobility. In FMTTM, we identify limitations within the joints, soft tissues, viscera and neurovascular tissues. Limited mobility in these structures can impair an individual's function. In a condition like Thoractic Outlet Syndrome, the Thoracic outlet is compromised, which brings forth symptoms. The idea is to retain that space so that there is no compression of Neurovascular bundle. Neural tissues are mobilised to minimise the symptoms. Mobilisation of joints - primary focus is to give a better alignment, to improve the mobility so that there is no pulling on neurovascular structures. Tight or hypertrophied muscles can be released so as to prevent impingement of the Neurovascular bundle i.e. artery, vein, nerve. Also, FMTTM focuses on synergistic activation of required muscles. This approach helps to retain the results that are gained through releases and mobilisation. Proprioceptive Neuromuscular Facilitation & CoreFirst strategies can be used to strengthen core muscles. It helps in identifying daily activities that could be the aggravating a particular condition and then helps in ergonomically transforming it.
Our Client Speak

Amanpreet is absolutely phenomenal and her guidance has been key for me in understanding the functioning of my body and maintaining correct postures for maximum impact. I use her tips and suggestions to date and wanted to share how grateful I am for the insights she gave.

- Samiha Aboobacker
VARDĀN is open for consultation & treatment sessions. You can book an appointment with our Functional Manual Therapist to avail our services. We are following stringent precautionary measures for your safety. To contact, you may call or mail us.
Please call 011-43580720-22, 8:30 AM to 6:00 PM
Monday to Sunday
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+91-9971112446, +91-9910955500, +91-9810306730, +91-9910855500
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Address: 16-A, Ring Road, Lajpat Nagar- IV, New Delhi 110024