Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) is the impingement of neurovascular bundle between the neck and the shoulder. Common areas of impingement occur within scalene triangle, costoclavicular space, and sub -coracoid space. Numbness, tingling, and radicular pain are common diagnoses that are often misdiagnosed leading to wasted time and resources for the patient. It is our goal at Mountain Land Physical Therapy to ensure that each patient is equipped with the knowledge of what may be causing their symptoms and the tools to manage them. It is most prevalent within men ages 20-30 and can often result after neck or shoulder trauma or a repetitive stress injury.

Complaints that indicate a screening for TOS include but are not limited to:

  • Shoulder pain radiating down the arm
  • Arm and hand feeling weak
  • Numbness and tingling in upper extremity between shoulder and hand
  • Numbness at night
  • Cold sensation and poor circulation on one side

Thoracic Outlet Therapist

Jake Todd, Physical Therapist

Phone: (208) 422-9826
Fax: (801) 422-9855

Jake Todd, PT, DPT

Clinic Director, Physical Therapist

Jake Todd earned his Doctorate of Physical Therapy from the University of North Dakota in 2021.

Through training and research on common causes of upper extremity numbness, I have developed a way to accurately evaluate to determine cause and create an effective treatment plan that can help patients avoid unnecessary surgery. The goal of each appointment is to have the patient leave more informed and with a tool to help them function easier in their day-to-day life.

Specializing in general orthopedics, Jake is trained in manual and manipulative therapy and treating patients experiencing neck pain, low back pain, sciatica and radiculopathy. Growing up playing sports, Jake knows the benefits of physical therapy. He is passionate about helping his patients understand what is happening within their bodies and giving them tools they will need to get back to doing the activities they enjoy pain-free.

Thoracic Outlet Syndrome testing to rule in:

Upper Extremity (UE) ROM including shoulder, elbow, wrist and hand

Cyriax release

  • Can indicate scalene mm, clavicle, first rib, or pec minor involvement

Allen test

  • Indicates pec minor involvement and impingement within sub-coracoid space

Adson’s test

  • Indicates scalene mm and first rib involvement

  • Specificity 18% to 87%, and sensitivity of up to 94%

UE nerve tension testing including Median, Radial, and Ulnar nerves

UE peripheral nerve cutaneous innervation

  • TOS will typically present along these distribution lines

Differential diagnosis testing to rule out Thoracic Outlet Syndrome

Cervical Impingement

  • Cervical ROM testing
  • Spurling’s compression and distraction
  • Myotomes
  • Dermatomes
    • If symptoms are felt along these distribution it will usually indicate cervical impingement at the nerve root

Cubital Tunnel

  • Tinel’s percussion over cubital tunnel (will reproduce symptoms down forearm to digits 4-5 if impingement is occurring at elbow) (sensitivity of 62% and specificity of 53% so not specific) takes <10 seconds

Carpal Tunnel

  • Tinel’s percussion over carpal tunnel (will reproduce symptoms into digits 1-3 if impingement is occurring at the wrist) (sensitivity of 38%-100% and specificity of 55%-100%) takes <10 seconds