Thoracic Outlet Syndrome

Christine Kearney, DPT Counterstrain Portland
Portland, Oregon


Thoracic outlet syndrome (TOS) is a compression of the neurovascular bundle as it exits the area between your collar bone and first rib called the thoracic outlet. Within the neurovascular bundle of the thoracic outlet are the brachial plexus (nerves), subclavian artery, and subclavian vein. Identifying TOS can be complex because there are many conditions that resemble TOS. There are three types of TOS: neurogenic, venous, and arterial. Symptoms vary depending on which tissues are affected. Compression of nerves can cause numbness, tingling, pain and weakness. Compression of the blood vessels can cause swelling, pain, arm fatigue, discoloration in the hand and arm and altered temperature sensations. Causes of TOS include poor posture, being overweight, repetitive activities, and injuries to the structures around the thoracic outlet such as the collar bone (clavicle). Congenital anomalies may also be a contributing factor such as having an extra rib.

Fascial Counterstrain Treatment

Fascial Counterstrain (FCS) utilizes a multi-system approach to treating your fascia making it an effective technique to treat TOS. During your session, a thorough evaluation will be performed to see which factors are the main causes for your TOS symptoms. Your assessment may lead the practitioner to the treatment of multiple systems within the first session such as periosteal (bone), myofascia(muscles), ligamentous, neural, venous and arterial systems. Treatment to all of these systems helps decrease the fascial tensions that are causing compression of the neurovascular bundle and causing the symptoms your symptoms. For example: The deep cervical fascia is a connective tissue that invests in the muscles of the neck and vertebral column. Tension in this structure can restrict movements of the neurovascular bundle. Restrictions in the sternoclavicular joint can cause further pressure near the first rib. Treatment to the sternoclavicular joint allows the clavicle to move more freely above the first rib. Fascia surrounding the brachial plexus itself could also be comprised and can be released with FCS. Treatment of the fascia of the veins and arteries can facilitate drainage of any swelling in the area and help bring increased blood flow to an area. All of this is done using a combination of gentle tissue glides and comfortable positioning guided by a system of tender points. By restoring normal mobility and draining swelling across multiple systems we create and optimal environment for healing so that your symptoms can resolve.