Thoracic Outlet Treatment

Thoracic outlet syndrome is a catch all phrase for a dysfunction of the neurovascular structures as they pass under the shoulder into the arm (source). The most common symptoms are numbness or tingling in the hand/fingers, pain anywhere from the shoulder down to the hand or a diminished grip strength. It can be an extremely frustrating condition but it can be treated.

How To Treat Thoracic Outlet

The treatment plan for thoracic outlet syndrome is multifaceted. The goal is to improve thoracic extension and restore posterior shoulder strength. This will open up the shoulder girdle and increase sub clavicular space to allow blood vessels and nerves to decompress.

  • Improve upper back strength
  • Nerve glides
  • Stop pressing overhead

Improve Upper Back Strength To Treat Thoracic Outlet

Virtually everyone has an underdeveloped upper back musculature. This leads to a plethora of shoulder injuries, thoracic outlet syndrome being one. The target muscles for this will be the posterior rotator cuff, rhomboids, rear delts and lower trap. Here are 4 quality exercises to strengthen the upper back and shoulder.

Face Pulls

  • Complete 3 sets of 12 reps
  • Progress to sets of 15 and then 20 reps
  • At 20 reps add weight and start back at 12 reps
  • 3x a week

Rear Delt Flies

  • Complete 2 sets of 15 reps
  • Progress to 20 reps
  • At 20 reps, increase weight and start back at 15 reps
  • 3x a week

Band Pull Aparts

  • Complete 3 sets of 20 reps
  • Progress by using a thicker band
  • 3x a week

High Pulley Cable Row

  • Complete 3 sets of 12 reps
  • Progress to sets of 15 and then 20 reps
  • At 20 reps add weight and start back at 12 reps
  • 3x a week

Nerve Glides For Thoracic Outlet

Nerve glides help to restore function to the nerve to decrease symptoms. The general concept is to shorten a nerve at one end and lengthen the other end. This is then repeated. See video below

  • Complete 30 reps in a single session
  • Repeat this twice a day
  • Perform these glides daily as long as needed to decrease symptoms
  • If the first video is too intense, start with the 2nd video
  • Build tolerance to be able to perform the the first demonstration

Stop Pressing Overhead For Thoracic Outlet

Overhead pressing is a movement that is not conducive for shoulder health. When the shoulder goes overhead, the sub acromial space decreases. Why is this bad? The nerves and blood vessels of the shoulder pass through this space and it leads to shoulder impingement (learn more here)

If you continue to do overhead press work, just know that you will delay or hinder the rehab for thoracic outlet syndrome entirely. If you insist on doing the movements, either reduce the volume or make variations to the exercises. For example if doing barbell overhead press, do a landmine press instead.

Thoracic outlet syndrome is a very complex issue. It can be treated but it will take a while. The condition did not develop overnight so the treatment will not be a quick fix either. The goal is to restore normal function to the shoulder and the symptoms should resolve.

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