Anatomy
The thoracic outlet is a term given to the space that is located between the clavicle (collarbone) and the first rib. This small space is crowded with the subclavian artery and vein, the subclavius muscle and the trunks of the brachial plexus, which is a bundle of nerve fibers that control the sensory and motor action of the upper extremity. The brachial plexus and the brachial artery or vein can also get compromised as it travels between the anterior and middle scalene, and more inferior and lateral under the pectoralis minor muscle. Another anatomical structure that can lead to TOS is a cervical rib, which is just an elongation of the transverse process of the vertebrae.
What Will You Experience?
Symptoms vary depending upon which nerve or blood vessel is being compressed. If this is occurring due to compression of the brachial plexus, there may be a vague aching in the neck, shoulder, arm, or hand. There may also be sharp pain, numbness, or tingling on the inside of the forearm and the fourth and fifth digits of the hand. In addition, there may be a feeling of fatigue or clumsiness in the involved hand. If it is the blood vessel that is being affected, there will be a decrease blood flow into the arm, which may result in swelling, redness, or feeling of coldness on the involved side. Shoulder range of motion may also be decreased, along with difficulty performing overhead activities. Symptoms from nerve compression are far more common than symptoms from arterial compromise.
What it Is?
Thoracic outlet syndrome is a term given to the wide range of mechanisms that lead to compression of either the trunks of the brachial plexus or the artery or vein. As mentioned above, structure that can cause this compression are the anterior scalene, middle scalene, subclavius muscle, the first rib, the clavicle, the pectoralis minor, or a cervical rib, which is a benign osseous anomaly. Compression of a neural structure leads to the sharp pain, tingling, loss of sensation, or weakness in the muscles of the forearm and inside of the hand. Compression of arterial or venous structures lead to swelling or redness, or even paleness in certain situations when the arms are raised above the head.
Predisposing Factors
This condition is more common in females due to the fact that cervical ribs are more prevalent in females. Also, you may be predisposed to this condition if you have poor posture, involving rounded shoulders and increased upper back curvature. In addition, people who do a lot of overhead work like carpenters and painters tend to be prone to developing this condition. Those people who sit at a desk all day with poor posture may also end up with the above mentioned symptoms. The final segment of the population that tend to develop thoracic outlet syndrome are athletes in sports such as volleyball, swimming, and tennis, who have to repetitively bring their arm overhead to accomplish their athletic task.
What Will Lake Marion Do for You?
At Lake Marion Chiropractic Center, your evaluation will begin with an in depth orthopedic, neurological, and chiropractic evaluation to differentiate the exact structure or structures causing your symptoms. Differentiating which tissue is causing your specific case of thoracic outlet syndrome is extremely crucial to an efficient and effective recovery. Treatment for this condition would begin with chiropractic care, to remove any joint restrictions found in the involved area such as the lower cervical spine, upper thoracic spine, first costo-sternal joint and the sternoclavicular joint. Next, one of the advanced soft tissue therapies, such as the Graston technique, would be utilized to assist with reduction of soft tissue restrictions and lengthening of the involved tissues. “Nerve flossing” may also be utilized to free the nerve tracts from any restriction along the involved muscles. Finally, strengthening exercises may be recommended to help improve posture, which will relieve pressure in the involved area. In some complicated cases, a x-ray or MRI may be warranted for further diagnosis and treatment.