This week I had 3 very different cases of Thoracic Outlet Syndrome come into my office. I thought it would be worth while discussing this condition in a little more detail. Lets give that a whirl!
When considering the thoracic out I think about 3 areas of concern:
- Neuro-vascular structures compromised: The brachial plexus, subclavian artery and vein
- Bony entrapment sites: cervical ribs, between the 1st rib and clavicle, or coracoid process
- Soft tissue entrapment sites: between the scales and/or pectoralis minor
I then review the symptoms with the patient and their presentation.
Common things I see and hear are:
- My whole hand (or 4th/5th digit) goes numb while sleeping, while riding my bike or swimming
- I get the feeling as though I’m wearing a sock around my arm (think arterial entrapment in scalenes or between the 1st rib and clavicle)
- I get discoloration in my arm and hand, especially during exercise (think arterial entrapment in scalenes or between the 1st rib and clavicle)
- I get swelling in my hand (think venous entrapment in pectorals minor)
- A decrease in the strength of (not the rate) the radial pulse when performing any of the many tests for thoracic outlet
- A classic “Upper Cross Syndrome” posture, where the primary issue can lie in the neck, shoulder, mid-back or a combination of them all. For this reason visit a skilled clinician for proper evaluation
From there I develop a treatment plan centered around reducing symptoms and maximizing the space through the thoracic outlet.
This usually encompasses some or all of the following:
- Improving tissue quality and tone through the chest and muscles of secondary respiration
- Improving upper thoracic and rib mobility
- Improving lower cervical spine stability
- Improving shoulder reactivity and peri-scapular stability
The reality is thoracic outlet syndrome is tricky. Often patients go months without a correct medical diagnosis largely due to the fact that symptoms are absent during testing. In my experience a doppler ultrasound, while symptomatic, along with EMG can help solidify a proper diagnosis and prognosis for the patient.
I hope this article has given you a few quick pointers when it comes to this very common condition.
Are you someone that suffers from thoracic outlet syndrome? Are you a clinician that treats?
As always we’d love to hear your thoughts!