ALH Guidelines for Treating Thoracic Outlet Syndrome (TOS)

Lymphedema is the swelling that occurs in an arm or leg, when lymph transport is blocked or impaired. It can be congenital, or acquired through infection; but most frequently it occurs post surgery - and may be most associated with breast cancer.

The thoracic outlet itself is just an area. It is the space between the collarbone and first rib, sensitive because of the nerves and blood vessels which travel through the space. Naming it a syndrome, alludes to the different pain presentations which can arise as a result of pressure affecting one sensitive tissue more than another.

Imbalance of the muscles surrounding the shoulder blade affects many shoulder presentations, including TOS. The following articles from the American Association of Orthopaedic Surgeons (AAOS) describe both the problem and the significance of the shoulder blade.

At Avalon Laser Health Physiotherapy and Wellness we believe in collaborative care; and our team consists of physiotherapy, massage therapy, laser therapy and acupuncture.

In this instance, physiotherapy must take the lead role. That the alignment in the upper shoulder/neck area should change sufficiently to apply pressure to the nerves and blood vessels in close proximity, is a pretty clear signal that alignment has to be addressed to effect lasting recovery. For the client’s benefit, physiotherapy needs a lead role here…fundamentally, it’s all about good muscle balance and control; and correcting alignment and position of the shoulder blade, neck and related areas.

As with all other conditions we see, there’s a large role for pain modifying modalities. It’s very difficult to focus on and accurately reproduce correct movement when pain overwhelms client effort. Massage and acupuncture play significant roles. It is, however, one of the rare pain presentations we see, that laser doesn’t figure prominently. Especially, with respect to the scapular stabilizing musculature, as it is the muscle length which is most compromised. Exercise, very focused and accurately reproduced, and regularly modified to elicit neural fatigue is what is of most benefit for scapular and related misalignment.

If early exercise doesn’t relieve the pressure on sensitive nerve and blood vessel structures, laser is used to settle inflammation within the thoracic outlet. Whatever the consensus on early treatment, for the client’s sake and for treatment success, it is the exercise program which is the key to lasting recovery.

For further information on the conditions we treat and services we offer, or to book an appointment please call 709-753-0155, email:

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