Thoracic Outlet Syndrome Massage

A Thoracic Outlet Syndrome (TOS) Massage is a specialized treatment focusing on reducing muscle tension, improving range of motion, and relieving neurovascular compression in the thoracic outlet area (between the collarbone and first rib). Massage targets muscles such as the scalenes, pectoralis minor, and upper back to alleviate symptoms and restore function.​

Signs & Symptoms

• Pain, numbness, tingling, and weakness in the neck, shoulder, arms, or hands

• Swelling or discoloration of the limb (particularly with vascular TOS)

• Symptoms worsened by certain arm or neck positions—lifting, overhead work, prolonged sitting

• Restricted movement in the neck, upper chest, and shoulder

• Muscle tightness, postural changes, and headaches are frequent co-occurrences.​

Contraindications

• Avoid deep or direct work over acutely inflamed or compromised nerves and vessels

• Do not treat TOS with suspected DVT, severe pain, open wounds, or active infection—refer to a physician

• Extra caution in clients with vascular compromise, cardiac conditions, or recent surgery

• Never use forceful techniques or aggressive stretching if symptoms worsen or if severe neurological compromise is present.​

Assessment

• Conduct a thorough assessment of symptom onset, aggravating factors, posture, and previous injuries

• Palpate scalenes, pectoralis minor, and upper back for tightness, trigger points, and fascial restrictions

• Perform special tests for TOS such as Adson’s, Wright’s, Halstead’s, and neural tension tests

• Assess range of motion and postural alignment

• Rule out that symptoms are referred from cervical spine or other local pathology.​

Treatment

• Gentle myofascial release, static pressure, and muscle stripping to scalenes, pectoralis minor, trapezius, and subclavius​

• Neuromuscular and trigger point therapy for muscle hypertonicity contributing to compression​

• Pin-and-stretch and active engagement techniques to lengthen and decompress affected muscles​

• Passive and active mobilizations to increase space at the costoclavicular and scalene triangle regions

• Treatment of associated tension in neck, shoulder, back, and arm muscles to optimize neural and vascular flow

• Session intensity is adjusted based on symptom response during and after treatment.​

Self Care

• Perform regular stretching of neck, shoulders, and chest (especially scalene and pectoralis minor) as taught by a therapist​

• Gentle self-massage to upper chest, neck, and arm, focusing on muscle relaxation around the thoracic outlet—not directly on sensitive or symptomatic areas

• Incorporate frequent posture breaks, ergonomic modifications at work, and avoid prolonged overhead activities

• Apply moist heat for muscle relaxation, but avoid on areas with acute swelling or neurological signs

• Engage in prescribed strengthening exercises for postural muscles to maintain long-term improvement

• Communicate with a healthcare team for persistent, severe, or worsening symptoms