Can Chiropractors Treat Thoracic Outlet Syndrome?

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Are you noticing severe symptoms such as numbness, tingling, and hand pain for a long? You might have TOS. Your frustration with not getting rid of the discomfort and restricted movement is genuine. You must read it to know other possible treatment options.

People are starting to consider non-surgical treatments like chiropractic care for TOS. So, can chiropractors treat Thoracic Outlet Syndrome? Yes, Chiropractic care, renowned for its non-invasive and holistic approach to health, is increasingly being explored as a viable treatment option for TOS.

With their in-depth understanding of the musculoskeletal system, chiropractors are well-equipped to manage and relieve the pain and discomfort associated with TOS. They apply various techniques and lifestyle recommendations to dampen the symptoms and improve the patient’s health.

In this blog, we will discuss the anatomy of the thoracic outlet, its pathophysiology, and different ways to diagnose and treat it, used by chiropractors.

Anatomy of Thoracic Outlet

The thoracic outlet is a small opening leading from the base of the k to the armpit and arm. The thoracic outlet is an anatomical region bordered by various structures that define its superior, anterior, and inferior aspects.

Superior Boundary

1. Skin

2. Fascia 

Anterior Boundary

1. Sternum

2. Clavicle

3. First rib

Inferior Boundary

1. First rib

2. Costal cartilage.

Structures Passing

The thoracic outlet has several key structures passing through it:


1. Brachial Plexus (C8,T1)


1. Subclavian artery

2. Subclavian vein

Lymph Nodes

Overview of Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) is a disease where nerves or blood vessels near your clavicle get compressed. This can cause pain, tingling, and numbness in your neck, shoulder, and hand.


                          Neurogenic         Venous                  Arterial 
Paraesthesias (numbness) Weakness of neck and arm Change of color of the hand and fingers to blue 
Cyanosis of hand Swelling of hands or arm Pain in the neck, shoulder, or arm
Colour change of hands and fingers to more pink or red and even mottled appearance Pallor of limb Sensitivity to cold
Dull pain in shoulder, armpit, and neck Pins and tingling sensations in limb and shoulder

How is TOS pain differentiated from angina?

Angina and TOS  pain are confusing. It’s important to mention the differentiating symptoms and signs.

  • On exertion, pain aggravates in angina while remaining constant in TOS.
  • Angina is associated with shortness of breath, but the other one is not.
  • TOS pain aggravates on lifting the arm, while in angina, it remains constant.

Causes/Risk Factors

There are many causes of TOS, including:

  • Physical trauma
  • Anatomical defects such as extra cervical rib
  • Tumors in thoracic outlet
  • Poor posture that causes nerve compression
  • Pregnancy
  • Repetitive arm and shoulder movements and activity, such as from playing certain sports and weight lifters.

What were Conventional Treatments?

Before diving into alternative methods like chiropractic care, it’s essential to understand what the conventional treatments for Thoracic Outlet Syndrome (TOS) are. These are the treatments that most doctors will recommend when they first diagnose someone with TOS. 

Here are some of them:

  • Physical Therapy: This involves a series of exercises targeted at stretching and strengthening the shoulder muscles to improve posture and relieve compression in the thoracic outlet.
  • Medications: Doctors often prescribe pain relievers, muscle relaxants, or anti-inflammatory drugs to help alleviate the symptoms of TOS.
  • Therapeutic Injections: In some cases, patients might receive injections of corticosteroids or Botox for pain relief.
  • Surgery: If other treatments don’t work, doctors might suggest surgery to remove the first rib or to release a muscle in the neck to make more room for the nerves and blood vessels.

How does a Chiropractor Diagnose Thoracic Outlet Syndrome?

how chiropractor treat thoracic outlet syndrome

Chiropractors always diagnose any disease through the following components:


The following are asked of the patient while taking their history;

  • Chief Complaints: Ask the patient about the main problems they are experiencing. Are they feeling numbness, tingling, or pain in their neck, shoulder, or hand?
  • Symptom History: Find out when these symptoms first started. Are there any specific movements or activities that make them worse?
  • Previous Medical History: Ask if the patient has had any similar issues in the past. Do they have any other medical conditions?
  • Lifestyle: Inquire about their daily activities, especially those involving the upper body. This could include their job, hobbies, or any sports they play.
  • Family History: Ask if any family members have had similar symptoms or diagnoses.
  • Previous Treatments: Find out if the patient has been treated for these symptoms before. Have they taken medications, undergone physical therapy, or had any injections or surgeries? What was the result of these treatments?


Motor Examination

  • Posture Assessment: The chiropractor first observes the patient’s posture. Any abnormal positioning, such as rounded shoulders or a forward-head posture, may contribute to TOS.
  • Strength Testing: Chiropractors assess the strength of the muscles in the neck, shoulder, and arms to identify any areas of weakness that could be contributing to the symptoms of TOS.
  • Range of Motion Testing: This involves checking the flexibility and mobility of the neck and shoulders. Limited or painful movements could indicate TOS.
  • Handgrip Strength Test: This test assesses the strength and endurance of the hand and arm muscles, which can be affected by TOS.
  • Reflex Testing: Reflexes in the upper limb are evaluated to identify any neurological changes.
  • Special Tests: Chiropractors may utilize special tests for TOS, like the Adson’s test, Costoclavicular test, and Roos test, to confirm the diagnosis and understand the severity of the condition.
  • Palpation: The chiropractor will palpate or feel the neck, shoulder, and collarbone area for any tenderness, muscular tension, or abnormalities.
  • Neurodynamic Testing:

Sensory Examination

Examination of TOS primarily involves testing the touch and pain sensation in the affected arm to identify any areas of numbness or reduced sensation. This often includes a Tinel’s sign test, where the doctor taps over the nerve in the brachial plexus area to see if it triggers any tingling or pain.


Following investigations are advised by chiropractors frequently:

  • Doppler ultrasound 
  • X-ray 
  • Nerve Conduction Studies
  • Electromyography 
  • CT scan
  • MRI

How Can Chiropractors Treat Thoracic Outlet Syndrome?

I hope that up till now, we have answered your question, “Can chiropractors treat Thoracic Outlet Syndrome. Now we are continuing with “How can chiropractors treat thoracic outlet syndrome?”.

Chiropractors adopt the following methods:

1. Heat Application

2. Interferential Current (IFC) Therapy

IFC Therapy is a non-invasive therapy technique that uses low-frequency electrical currents to stimulate muscles and nerves, aiding in pain relief and promoting healing. This therapy is often utilized in cases of deep tissue injury where conventional electrical stimulation cannot reach, making it an effective option for patients with TOS.

3. Spinal Adjustments 

For patients diagnosed with TOS, chiropractors may perform cervical, first rib, and cranial adjustments to ensure proper alignment of the spine. Misalignment can cause nerve irritation and muscle tension, contributing to TOS symptoms. 

4. Active Release Technique

This is a special type of massage. It helps ease tight muscles and increase movement. The therapist applies pressure and stretches the muscles. This can help reduce pain and improve function. It’s often used in treating injuries.

5. Shockwave Therapy

In severe cases, doctors also do shockwave therapy. This therapy is helpful in the removal of adhesion and scars in severe cases.

6. Therapeutic Exercises

In addition to the treatments mentioned above, chiropractors often recommend therapeutic exercises tailored to the patient’s specific condition. These exercises aim to strengthen muscles, improve posture, and increase range of motion, thereby helping to alleviate the symptoms of TOS over time.


A chiropractor may also guide a patient on lifestyle modifications, such as adjustments or posture correction, which can contribute significantly to recovery and prevention of symptoms recurrence. The counseling process also provides an opportunity for patients to address any concerns or fears, thereby nourishing a supportive therapeutic environment.

Case Study

Patient Profile

John Doe, a 45-year-old software developer, leads an active lifestyle but spends long hours working at his desk. He has a history of intermittent neck pain and recently started experiencing numbness and tingling in his right arm and hand.

Presenting Complaints

John presented with complaints of constant dull ache in his neck, shoulder, and arm since last year. He also reported a sense of weakness in his hand, making it difficult for him to grasp objects. These symptoms worsened during his work hours, particularly while using the computer.

Treatment and Progression

John’s treatment plan was tailored to his specific condition, incorporating chiropractic adjustments, therapeutic exercises, and lifestyle modifications. The chiropractic care primarily consisted of spinal adjustments aimed at correcting misalignments causing nerve irritation. 

Therapeutic exercises were recommended to strengthen his neck and shoulder muscles and improve posture. He was also advised to make some ergonomic changes to his workspace.

Over six weeks, John reported significant improvement in his symptoms. The dull ache in his neck and shoulder subsided, and the numbness and tingling in his hand lessened. He also noticed an enhanced range of motion and increased strength in his hand.

In John’s case, chiropractic care proved to be an effective treatment for TOS. The chiropractor played a vital role not only in addressing the physical symptoms but also in educating John about his condition, its causes, and preventative measures.


1. What is the best treatment for thoracic outlet syndrome?

Chiropractors have a crucial role in this multipronged approach. They perform hands-on treatments, like spinal adjustments, to correct any misalignments that might be causing nerve irritation. They also use techniques like manual trigger point therapy and myofascial release to relieve muscle tension and knots that might contribute to TOS.

2. Who should not get a chiropractic adjustment?

People who are prohibited from taking chiropractic care:

  • Osteoporosis
  • Risk of stroke
  • Any bone tumor
  • Cancers 

3. What is the best position for thoracic outlet syndrome?

The best position for Thoracic Outlet Syndrome (TOS) is typically one that promotes good posture. This often includes standing or sitting upright with the shoulders pulled back and the neck aligned over the shoulders.

4. What kind of doctor fixes thoracic outlet syndrome?

Thoracic Outlet Syndrome (TOS) can be addressed by various types of doctors, depending on the severity and specific nature of the condition. A chiropractor can often help manage the symptoms of TOS through spinal adjustments and other non-invasive treatments. However, in more severe cases, you may need to see a specialist like an orthopedic surgeon, who can perform surgery if necessary.

Bottom Line

Chiropractors can effectively treat Thoracic Outlet Syndrome (TOS) through spinal adjustments, therapeutic exercises, and lifestyle modifications. These healthcare professionals provide hands-on treatments, relieve symptoms, and educate patients about their condition and its management. In severe cases, other specialists like orthopedic surgeons may be required. 

However, chiropractic care often plays a crucial role in managing TOS, improving patients’ quality of life, and improving self-management of the condition.

We hope that you gained enough knowledge from our blog. In case of studying chiropractors’ role in other diseases, visit our site. Thanks to Dr.John for sharing your case study with us. 


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