Disease of the Week – Thoracic Outlet Syndrome
Tue, Nov 17, 2009
This week, I wanted to cover something that’s not necessarily a disease, but a bio-mechanical problem that can cause quite a bit of trouble. So we’ll be talking about Thoracic Outlet Syndrome (TOS).
First of all, TOS is actually a group of conditions that involve nerves and blood vessels coming out of the thoracic outlet between the collar bone and first rib. In TOS, the vessels or nerves become compressed between the two bones to cause neck, shoulder, and upper arm pain, while causing numbness of the hands.
A lot of things can cause Thoracic Outlet Syndrome, typically trauma. Doing repetitive movements (like assembly line work or pitching in baseball) over and over may cause this, as well as developing extra ribs in your cervical spine. Obesity and pregnancy are sometimes the culprit in TOS. Many times, doctors are unable to pinpoint the exact cause because even older injuries can lead to TOS over time.
There are three major types of TOS. As you may imagine, it depends on what exactly is being compressed.
Neurogenic TOS (aka Neurological TOS) – This is when the brachial plexus of the neck is compressed. The symptoms of this are typically neurological in nature: like inability to separate your fingers or loss of the ability to bring your thumb against the side of your palm (in general, a weakened grip). You may experience the numbness along the side of the arm and hand, where the pinky and ring fingers are.
Vascular TOS – This is when either the subclavian artery or vein (or both) are compressed between the rib and collarbone. In this you’ll more than likely experience a deep, aching pain that’s pretty generalized to the shoulder, neck, and arm. The difference between this and a neurological compression is that the neurogenic TOS is mainly experienced around what those in the medical community call your medial arm, while the artery and vein being compressed can affect the whole arm. Also, initially you may not experience muscle weakness with vascular compression, however, you may see a blue discoloration especially in the hand and experience a dull throbbing at the base of the neck around the collarbone.
Non-specific TOS – This is very non-specific pain at the thoracic outlet, so around the lower neck and shoulders. Many of the other symptoms will vary.
This is one of many conditions where conservative treatment, like chiropractic and physical therapy, can shine. Not only can correcting poor posture or bad ergonomics help to correct the problem, but actually adjusting out of place ribs or around the area compressed, as well as, strengthening the muscles of the shoulder and neck to open the thoracic outlet up to relieve the symptoms. Obviously, it’s not a guarantee that just chiropractic or PT will correct the problem. There are some cases where surgery may be necessary. So if you’re experiencing these symptoms, consult with your chiropractor to see if they can help or if you need to see an orthopedic or vascular surgeon.
Your doctor should also give you instructions on how you can help correct the problem. As we discussed, proper posture and ergonomics, also taking breaks to give the muscles a break, and relaxation methods can help ease the tension of the area. Like most diseases, it’s usually best to prevent them, so avoiding repetitive movements and constant heavy lifting should help you from experiencing this. But if you feel like this is describing you, don’t put it off since prolonged TOS can cause nerve damage and degeneration.
Image Credit: www.health-res.com
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Tags: thoracic outlet syndrome
Just watched your latest video, very impressive…are you delving more into Fibromyalgia yet? I missed one week, and did notice it, so it does make an amazing difference, in my case anyway. Be well!
Thanks for the vote of confidence on the video, Debbie. You know, fibromyalgia is a bit of a tricky thing to talk about since there’s so much debate around it: does it really exist? How is it diagnosed? So on and so on. So I wasn’t really thinking of doing another post, however, perhaps you’d be interested in talking about your experience with it? I don’t know, just a thought. It would be like my brother’s experience in the post “Importance of a Physical Exam.” Let me know.