Thoracic Outlet Syndrome, aka TOS, is a rare condition that involves pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip. The thoracic outlet is the area between the rib cage and collar bone. The cause of TOS can be due to several factors and depending on which anatomical structures are compressed: arteries, veins, or nerves. Compression can be of different magnitude in each of these structures. Therefore symptoms can be protean.
Due to involvement of the medial cord of the brachial plexus, the ulnar nerve is most impacted by this compression syndrome. Pain and tingling in the neck and shoulders can occur. Carrying something heavy may make the pain worse or cause muscle weakness. Compression of arteries may result in pain, paleness of the skin, and decreased skin temperature. Compression of a vein will result in edema. Pain, numbness, and tingling in the pinky and ring fingers, and the inner forearm. Other signs of poor circulation in the hand or forearm includes bluish color, cold hands, or swollen arm.
There are 4 main areas where compression may occur: 1)The anterior and middle scalene (aka the interscalene triangle). The brachial plexus and subclavian artery pass through here, but it is the medial cord of the plexus, arising from the C8-T1 nerve roots, which is most likely to be affected. 2) Pectoralis minor – hypertonicity of this muscle will compression the subclavian artery as it becomes the axillary artery when it passes deep to the clavicle. 3) Costoclavicular – compression occurs between the 1st rib and the clavicle. This is most likely to be a result of injury to the clavicle, such as a break or dislocation, and is prone to affect the vasculature, as the axillary vein becomes the subclavian vein. 4) Presence of a cervical rib – the presence of an extra rib is determined by an x-ray, and it interferes with the size of the interscalene triangle, therefore allowing less room for the plexus and vasculature.
Thoracic Outlet Syndrome usually affects people whose posture tends to be very forward and slumping. Think of a person who sits at a desk all day, or who does a lot of work moving forward (massage therapist or dentist). Others at risk may also have “military posture”, extreme retraction of the shoulders which pulls the pectorialis minor tight over the plexus and artery, thus compressing it. Also at risk are people who have had a broken or dislocated clavicle, especially those with a more complicated or compounded break. Due to the attachment of the scalenes and pectoralis minor on the ribs, people who have a respiratory disorder and difficulty breathing often recruit these muscles, thus increasing the incidence of hypertonicity, and the presence of myofascial trigger points.
Thoracic outlet syndrome, like any other condition that affects the nerves, muscles and blood vessels, needs to be treated as soon as symptoms become apparent. Visiting your Chiropractor or physician should be your first order of business. In most instances the Chiropractor is best suited to treat the nerve impingement that is certainly present. He/she will find the cause of impingement and treat the patient to remove the causative factor. If all fails, surgery should be your last resort.
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