Thoracic Outlet Syndrome

The vast majority of us will experience thoracic outlet syndrome (TOS) at some point in our lives.  Most of you will not recognize the diagnosis, but when you hear the symptoms, that may change.  Some of you might be experiencing TOS right now so let us look into this condition further.

What is it?

Compression and irritation of the nerve bundle, the brachial plexus, which travels from the neck to the upper extremity on either side.  There are 3 areas where these nerves can be impeded by the surrounding structures before they enter the arm.

Do you have it?

The common symptom picture may include pain, discomfort, weakness, numbness, or tingling sensations.  The symptoms could remain in the neck region or show up in the head, upper arm, or even into the fingers.  The symptoms will likely appear or increase in severity during prolonged use of that arm or when raising the arm past shoulder level.  

What caused it?

Barring any direct trauma to the neck or shoulder, common causes include:

1. Repetitive throwing motions such as a baseball pitcher.

2. An anatomical abnormality such as a cervical rib which decreases the natural space for the brachial plexus.

3. Excessive shrugging or improper shoulder exercises.

4. Poor neck support while sleeping.

5. Overuse of that arm.

6. Psycho-emotional conflicts. 

How we treat it

1. Chiropractic manipulation of the cervico-thoracic junction.  A subluxation here can put the scalene muscles under tension due to their attachments to the vertebrae and ribs. 

2. Soft tissue mobilization which releases tension in the deep neck muscles or pec muscles.  This opens up free flow of the nerve bundle. 

3. PNF stretching: performing a contract/relax sequence followed by passive stretching introduces more range of motion and alleviates pressure on the nerve bundle.

4. Nerve flossing: we demonstrate how to perform this technique which restores the natural glide of the brachial plexus and the nerves traveling down the arm.