Thoracic outlet syndrome and wrist pain

Hi Physios
I would just like some advice. I'm seeing a new physio who is treating my wrist pain. I've been referred by my doctor to her. She suspects that I have thoracic outlet syndrome and that the pain that I am experiencing in my wrist has something to do with TOS. I have a shoulder injury (torn capsule and bicep tendonitis) on my right shoulder and it's settled down quite a bit and rarely causes my much pain now. I haven't had any investigations done on my thoracic but my sports doc has always said that my first rib and thoracic is very tight and he has occasionally said that I have TOS.

She has said that I should refrain from doing weights and that walking and aerobic activities are going to be much better for me like swimming. I understand that aerobic activity is important for people who have thoracic issues but it's not clear why weights training is not appropriate. I'm uncomfortable with the idea about not training because 1) it doesn't aggravate things and resistance training is more preventative for me and 2) I have weak core muscles and I need to strengthen it at some point

The treatment is working well. She's mainly trying to free up the thoracic and the brachial plexus and it does stop the pain in my wrist. The thing is if I don't do resistance work my body won't have the endurance/strength to be able to work a desk job and I need to stay conditioned if I continue to dance. Resistance training does not hurt my shoulder and it doesn't aggravate my wrist. So I'm in a double bind. Can someone recommend some alternatives? Plus I've been told that swimming is supposed to be very good for me. My old physio has always been against it because it forced my right shoulder into too much internal rotation. Swimming does aggravate both shoulders and wrists so I'm not sure what my alternatives are. I am also contemplating going back to see my sports doctor who may be able to recommend something more appropriate for my rehabilitation.

Greatly appreciate your help.

I'd think the refraining from weights is only temporary, while she's releasing the tight muscles that are causing the TOS (usually scalenes and pectoral muscles) and bony areas (1st rib). Normal physio progression would get you back to doing strengthening activities that balance what is going on with you. It is possible you may have been doing certain strength exercises that contributed to your TOS even though it seems like they haven't caused any noticeable effects for you while you're doing them.

And, swimming, yes, it can cause TOS troubles in some people. So making sure to let your physio know it doesn't work for you, so she can recommend a better choice for you.

Hi violablue
Thanks for your advice. I would hope that the refraining from weights is temporary. I understand that flexibility is v important for people with thoracic issues. I'm not sure what my physio really does. She seems to do a lot of work around the brachial plexus and manipulating the spine to help get more rotation. Once she does all this, my ROM for my neck and pain in the wrist just disappears.

I guess I should clarify which strength exercises contribute to the TOS and which ones don't. I do find that scap stabiliser work is so important for me so I'm hoping that this won't get taken off the list.

My physio mentioned that people with thoracic issues are most likely to be at more risk of developing over use injuries. Do you know much about this and how does one prevent this from happening again?

Hi SalsaQueen,

In some literature TOS is classified as a repetitive strain injury. In others, it is noted that repetitive strain injury is a major cause of TOS.

Here's an interesting webpage that has a number of different approaches and views to TOS: Thoracic Outlet Syndrome: OverviewAnd an interesting point is if a nerve has a some type of injury, compression, crush, etc, it is more susceptible to injury with any other compression or crush along the nerve pathway. This is known as double crush syndrome.

Avoiding compression or crush on the nerves is a good place to start. So that's where avoidance of certain activities comes in. Releasing the compression on the nerves is the main part of treatment. Then maintaining muscle balance through stretching and strengthening comes into play.

Good luck with your treatment! I've experienced TOS myself and it is not a life sentence. So learn all you can and take those TOS relieving strategies into the future with you.