Thoracic Outlet Syndrome
Published in the Times Standard
          In my article on shoulder/arm/hand pain, numbness and tingling, I talked about the involvement of the brachial plexus. Another related area of brachial plexus involvement to the arms and hands is the thoracic outlet.  It is located at the base of the neck under the clavicle above the first rib to the armpit.  The thoracic outlet syndrome (TOS) is compression of the nerves and blood vessels passing through this outlet.  Ninety-five percent of the time it is neurological, involving C8 and T1 spinal nerve roots of the ulnar nerve (90% of the time). Patients often complain of their hands and/or arms being numb or tingling with their arms up while driving or sleeping.  Other symptoms can range from headaches, neck/shoulder/arm/hand pain, weakness and numbness, to impaired circulation causing discoloration and coldness of the hands. This circulation problem relates to compression of the subclavian vein or artery in most cases.
            Some of the causes of TOS are: trauma, or repetitive actions, anatomic anomalies, poor posture, and neurovascular entrapment at the 1st rib and clavicle space.  Whiplash accidents cause trauma to the supporting structures and soft tissue of the cervical spine and the thoracic outlet as well. Muscle spasms and tightness of the cervical muscles, especially in the front of the neck, called the scalenes, can narrow the thoracic outlet causing thoracic outlet symptoms.  Repetitive movements with the arms above the head and shoulders for long periods of time also affect these muscles and the thoracic outlet. Occasionally a patient may have an extra rib or fibrous band formed off the C7 vertebra that interferes with the thoracic outlet.  One’s slouching position with the head forward will impinge on the plexus and vessels in the thoracic outlet.  Misalignment of the first rib or clavicle in relation to each other will cause neurovascular entrapment with TOS symptoms
       To determine if TOS is the problem, some simple arm tests can be performed to elicit the symptoms. Certain points of tenderness will be found at specific areas of the cervical spine and shoulders. X-rays can be taken to delineate a cervical rib or fibrous band, as well as an MRI or CT scan for soft tissue involvement. Nerve conduction tests are often used to distinguish the nerve involvement.
       Most TOS symptoms can be eliminated with proper adjustments to the 1st rib or clavicle and thoracic spine as well as any cervical spine involvement. By removing pressure on nerves and nerve roots through the thoracic outlet, nerve flow is restored and the irritation, numbness and tingling reduced. As the scalene muscles relax with the adjustment the small passageway for the brachial plexus and blood vessels enlarges, relieving more pressure. Specific stretching exercises for the neck and shoulders are often needed to help maintain the corrections. In some instances surgical resection of the 1st rib and/or scalene muscles is performed.  This should be your last resort when every other attempt has been tried and you’re losing use of your arm and hand.
Call our office for a free consult to see if yours could be a Chiropractic problem.  Most TOS can be treated and eliminated through conservative Chiropractic care “Naturally.”
Crosbie Chiropractic
Michael H. Crosbie, D.C.
1828 Main Street
Fortuna, CA 95540
(707) 725-5668