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Always seek medical advice first, when dealing with neck, back, hip or shoulder pain or limitation. Severe nerve root or spinal cord impingement needs more than exercise or any of the passive therapies.

Thoracic Outlet Syndrome

1. Symptoms of Thoracic Outlet Syndrome
2. Poor Posture and Thoracic Outlet Syndrome
3. Depressed/Droopy Shoulders
4. Scalenus Syndrome

1. Symptoms of Thoracic Outlet Syndrome – Numb Fingers, Hands and More. Several nights a week, I would be awakened from sleep with numb fingers and hands. I would sit up in bed and shake my hands until the feeling came back. This was one of the seemingly unrelated symptoms (headaches, shoulder impingement pain, and big toe pain) that disappeared when my posture improved. Night–time numbness and tingling in hands and arms are symptoms of Thoracic Outlet Compression Syndrome (TOS).

The Thoracic Outlet is a narrow passageway between collarbone (clavicle) and ribs that the subclavian artery and vein, and the brachial plexus (a network of nerve fibers formed from the lower 4 cervical and first thoracic nerve roots) must travel through to get to the arm. The nerves of the brachial plexus control most arm and hand muscles, and receive sensory input from the skin and muscles of the arm.


2. Poor Posture and Thoracic Outlet Syndrome: Hunched posture and downwardly tilted shoulder blades causes tightness in front shoulder muscles; this narrows the thoracic outlet in the shoulder, and may compress the brachial plexus and/or subclavian artery that runs through it. Symptoms include waking from sleep## with numbness, tingling, weakness, and coldness of hands and arms. Neck muscles, particularly the upper trapezius, may be painful. Most patients improve with therapy for posture and muscle imbalance. See the Medscape article: Thoracic Outlet Syndrome Treatment & Management. Kendall et al, discuss a similar syndrome, Coracoid Pressure Syndrome, where the brachial plexus is compressed by the coracoid process of the shoulder blade, which in hunched posture has been pulled forward and down by a tight pectoralis minor. Symptoms are pain down the arm with slight pressure over the area of the coracoid. Also pain that worsens with weight on the shoulders from a backpack or purse, or when carrying anything heavy with that arm. The upper trapezius is often in "protective spasm" from trying to lift the shoulder girdle off the nerve bundles. First line of treatment is to realign posture and shoulder blade position. See Fix the Shoulder Blade Exercise
## sleep position may aggravate TOS caused by slouched posture. Sleeping on the back forces the shoulder blades to tilt backwards so they lie flat against the bed. This pulls on the pectoralis minor, which overlays the brachial nerve bundle. If the pec. minor is already short and tight due to slouched posture then sleeping on the back may worsen the nerve compression.


3. Depressed/Droopy Shoulders, the clavicle (collarbone) is horizontal or slopes down to end of shoulder. The acromion process of the shoulder blade is also held too low. There are two areas of possible nerve and blood vessel compression in the thoracic outlet: 1. between clavicle and first rib, and 2. between coracoid/short tight pectoralis minor and the 3rd through 5th rib. The upper trapezius is stretched and weakened, but protectively spasms to lift the clavicle off compromised structures. Weight-bearing by the arms worsens the compression and stress on upper trapezius. (Depressed shoulders may be seen in weight lifters, who let heavy barbells and dumbbells hang off their collarbones, which pulls them lower and overstretches the upper traps. Also some female dancers, actors, and models, intentionally strive for a long swan-like neck, which depresses the shoulders.)

Another possible cause of arm pain originating in the thoracic outlet area may be an "Elevated First Rib" which would predispose to compression under the collarbone. The first rib elevates (within the relatively rigid structure of the ribcage) by action of the anterior and middle scalene muscles.


4. Scalenus Syndrome (Scalenus Anterior or Anticus syndrome) — The anterior and middle scalenes are also involved in a third possible area of thoracic outlet compression. Between them is a narrow area through which the brachial nerves and subclavian artery (not the subclavian vein) travel before passing under the collarbone. Turning the head, which causes twisting of the neck, narrows the passageway, but rarely causes symptoms from nerve compression unless there are predisposing factors. These include presence of a cervical rib (additional rib-like structure extending from the C-7 vertebra), enlargement of the scalenes due to exercise, (see abstract: Exercise-Induced Scalenus Syndrome) and chronic tightness/spasm, which manifests as a rotation of the head toward the spasm, and sometimes a head tilt toward the same side as the spasm but not always.


 

 

 

 

© 2017 Rochelle Cocco