Many patients complain about numbness or tingling in their hands when working at the computer, when they are driving, or when they wake up in the morning. This is usually accompanied by tight and achy neck, shoulder, and chest muscles as well as pain that can radiate down the arm to the hand. Although there are a number of conditions that can present with these symptoms, one of the most common is Thoracic Outlet Syndrome (TOS).
What is Thoracic Outlet Syndrome?
Thoracic Outlet Syndrome (TOS) is an umbrella term that refers to conditions that involve compression of the nerves, arteries, and veins in the lower neck, upper chest, and shoulder areas.
In order to understand this syndrome we must first consider the body’s anatomy. The thoracic outlet is the opening or space between the collarbone (clavicle), ribcage, and a group of neck muscles called the scalenes. The nerves exiting the cervical spine come together to form the brachial plexus as they pass through the thoracic outlet. This bundle of nerves runs between the anterior and middle scalene muscles, then courses down through the soft-tissues passing in front of the first rib and behind the clavicle before branching out into the arm. There are also arteries and veins that accompany the nerves as they pass through this anatomical passageway.
TOS may present as one of three different types, Arterial, Venous or Neurogenic. Statistically neurogenic TOS is by far the most common, comprising over 90% of all cases. Symptoms may include pain, numbness, tingling and weakness in the arm(s) or hand(s) as well as in the neck, shoulder(s) and upper chest.
What Causes Thoracic Outlet Syndrome?
There are many causes of TOS, including physical trauma (e.g. whiplash), poor posture, and repetitive arm and shoulder movements. The majority of cases can be attributed to myofascial restrictions in the neck (scalenes), shoulder (deltoid, rotator cuff), and upper chest (subclavius, pectoralis minor), all of which can lead to nerve entrapments as well as muscle imbalances and dysfunction.
When restrictions or adhesions form between the scalene muscles, nerves can become compressed or trapped between the soft-tissue layers. This compromises nerve function by not allowing the nerves to glide freely between the soft-tissue layers and sets off a vicious circle of inflammation and continual nerve irritation. Accordingly, adhesions between soft-tissue layers in the upper chest and below the clavicle can refer pain down the arm and add to faulty biomechanics and poor posture by pulling the shoulder forward creating imbalances throughout the chest, upper back, and shoulder girdle. Joint restrictions in the cervical and thoracic spine, as well as between the collarbone (clavicle) and chest bone (sternum) and between the first rib and first thoracic vertebra, can lead to decreased mobility and compensatory movement patterns in the neck, shoulders, and chest further adding to the development of the syndrome.
What can we do to treat or even prevent TOS?
At Kinetic Health we approach all cases of Thoracic Outlet Syndrome from a full body perspective. We look at the body as one functional unit and take into account each individual patient’s unique health history, daily routines (both at work and at home), postural habits and all other factors that may contribute to the development of their condition. Soft-tissue restrictions in the neck, shoulders and chest are treated with various treatment methods (ART, Graston, and Fascial Manipulation) to allow free movement between the muscles, fascia, tendons and nerves involved in TOS. Chiropractic mobilizations restore normal ranges of-motion-to restricted joints and allow for better movement between the bony architecture that makes up the neck, shoulder girdle, and upper chest.
By combining soft-tissue and chiropractic treatment methods, we ensure that we are taking into account all the underlying causes of the condition and that we are not simply treating the symptoms. Our goal is to resolve your condition, and in most cases we can effectively do that in a short period of time. In addition to treatment, we prescribe specific functional exercises to our patients in order to promote healing, increase strength and flexibility and allow for optimal nerve function. We place a great deal of emphasis on nerve flossing exercises when treating TOS. These exercises promote normal gliding of the entrapped nerves between the myofascial tissues and help to reinforce the changes that have been made during treatment. It is important to understand when performing these nerve flossing exercises that the nerves are continuous from the spinal cord down to the finger tips and that these exercise address the entire kinetic chain.
If you would like more information about treating this or other conditions, or would like to book an appointment, just give us a call at the clinic (403-241-3772) or visit our website at www.kinetichealth.ca.
