Understanding Thoracic Outlet Syndrome

Understanding Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) refers to a group of conditions that often cause neck, upper back pain and shoulder pain. TOS causes pain that feels deep within the shoulder and is often coupled with weakness and numbness into the arm and hand. In most cases only one side of the body is affected. Chiropractic care could help individuals deal with this pain. 

TOS is caused by a compression of the blood vessels or nerves, or both, as they pass through the Thoracic Outlet Space which is located in the shoulder region. The space is bordered by our collarbone, 1st rib, and the scalenes muscle in the front of the neck.  

TOS is categorised based on what structure in the neck is being compressed. Vascular TOS refers to compression of the blood vessels and often causes a cold and pale hand on the affected side due to restricted blood circulation. Neurological TOS refers to compression of the nerves and accounts for more than 90% of cases. The brachial plexus is a bundle of nerves that branch away from the spine in the neck and upper back and control movements and sensation in the arms. When a part of this nerve bundle becomes compressed it accounts for neurological TOS symptoms. Neurological TOS accounts for pain, numbness, tingling and weakness into the arms and hands. Often people suffering from neurological TOS will describe a tiredness’ or ‘fatigue’ in the arms and hand muscles of the affected side.  

TOS can be caused by traumas including motor vehicle accidents, whiplash type injuries and sports injuries. In most instances TOS develops progressively over time as a result of poor postural habits and rolled shoulders, stress and muscular tension and excessive overhead arm and shoulder movements. Diagnosis involves a thorough medical history and appropriate neurological and orthopedic examination. Further investigations including X-rays can be helpful in identifying underlying structural factors that may be contributing to the condition.  

Treatment of TOS involves identifying and addressing the underlying structural issues of the neck, spine and shoulder to encourage more space in the Thoracic Outlet for the tissues to pass through without being compressed, An emphasis on improving thoracic kyphosis (excessive rounding of the mid and upper back) and forward head carriage is important. This is often coupled with stretching of the scalenes and pectoralis muscles to reduce roundedness in the shoulders. A technique unique to the Advanced Biostructural Correction(ABC) protocol used at Clinic 27 is the use of meningeal releases, a powerful stretching technique of the spinal nerves which can help to reduce neural tension, specifically in the brachial plexus.  

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