Recognizing Thoracic Outlet Syndrome

The thoracic outlet is a small space between the collarbone (clavicle) and the first rib. Thoracic Outlet Syndrome (TOS) is a group of disorders that involve compression, injury or irritation of the nerves, blood vessels or veins in the thoracic outlet. This can cause pain in the shoulders and neck and numbness in the fingers. This has been a very common problem with patients presenting in my office very recently. A big contributor to this condition is poor sitting posture while working with technology. Obviously working from home or e-learning has increased dramatically and thus so has TOS.

What are the causes?
The cause of the compression can vary and may include:

• Anatomical defects present at birth, including an extra rib located above the 1st rib, or an abnormally tight fibrous band connecting the spine to the rib.
• Poor posture: drooping the shoulders or holding the head in a forward position can cause compression.
• Trauma: A traumatic event, such as a car accident, can cause internal changes that then compress the nerves or blood vessels.
• Repetitive activity: Doing the same activity over and over can wear on the body’s tissues. You may notice TOS symptoms if your job requires continuous repetition of movement, such as typing on a computer for extended periods, working on an assembly line, stocking shelves, or repeatedly lifting things above your head.

What are the symptoms?
The symptoms of thoracic outlet syndrome, as well as their intensity, vary between individuals and depend on the location of the compression site. When nerves are compressed, signs and symptoms often include:

• Numbness or tingling in the neck, shoulder, arm or fingers
• An ache in the arm or hand
• Weakening grip
• Difficulty with fine motor tasks

Compression of one or more veins and arteries can result in symptoms such as:

• Bluish discoloration of the hand
• Swelling or puffiness in the arm or hand
• Coldness of hands or fingers
• Throbbing lump near the collarbone
• Deep pain in the neck and shoulder region that may increase at night
• Arms and hands that are easily fatigued

How is it diagnosed?

• Because TOS doesn’t have unique symptoms, it can be difficult to diagnose. It is important to differentiate TOS from other conditions, such as carpal tunnel, shoulder tendonitis, or a herniated cervical disc.
• A detailed health history and thorough physical examination are the most important components in establishing the diagnosis of TOS.
• Diagnostic imaging or lab tests might be recommended to help confirm the TOS diagnosis.

How is it treated?

• In the vast majority of cases, a conservative, non-surgical approach to treatment is most effective. A chiropractic treatment plan for TOS may include a mix of joint mobilizations, physical therapy modalities, home stretching exercises, and soft tissue therapy.
• Patients should avoid prolonged positions that cause them to hold their arms out or overhead. For example, avoid sleeping with the arm extended up behind the head. It is also helpful to have rest periods at work to minimize fatigue.
• Weight reduction can be helpful for overweight patients. Also, try avoiding sleeping on the stomach with arms above the head, or performing repetitive lifting of heavy objects.
• A home exercise and stretching program can be a very valuable aspect in the treatment of TOS. Make sure to consult your Chiropractor prior to starting a new exercise program, as they can help develop an individualized program and provide instruction on proper stretching technique.

If you believe you are suffering with Thoracic Outlet Syndrome or some other physical wellness injuries make it a point to contact Dr. Max Barrett at North Shore Physical Wellness. We offer chiropractic, physical therapy, acupuncture, and custom orthotic solutions to help treat a wide array of conditions. NSPW is in-network with most major health insurance companies including Medicare.