What is a Thoracic Outlet Syndrome (TOS)?
Thoracic Outlet Syndrome (TOS) is a condition we treat commonly at the clinic. TOS is a condition thought to be caused by the compression of the nerves and blood vessels more specifically the brachial plexus, or subclavian artery or vein found in the area where these vessels exit the neck and enter the shoulder. The thoracic outlet is an anatomical area between the collar bone and the first rib. Nerve and blood vessel compression can occur at more than one place in the thoracic outlet: between the first rib and the collar bone known as the costoclavicular space, within an area between muscles known as the scalene muscles known as the interscalene triangle, and in a space between the coracoid process (bone in the shoulder) and tendon of the chest muscle (pectoralis minor muscle) known as the subpectoralis minor space. Depending on the location of the compression site and the structures involved will help the practitioners determine which type of TOS you may be experiencing.
Types of Thoracic Outlet Syndrome:
● Vascular (blood vessel) TOS
● True Neurogenic (nerve-damage) TOS
● Non-specific Neurogenic (nerve-related) TOS
Both vascular and true neurogenic TOS are extremely rare and often require urgent referral for further assessment such as an electrodiagnosis. The most common form of TOS we see in the general population and treat at the clinic is non-specific neurogenic TOS. This type of TOS temporarily compresses the brachial plexus but does not result in structural damage to the nerves.
What does Thoracic Outlet Syndrome feel like?
Individuals with non-specific neurogenic TOS will present with mild neurological symptoms such as numbness and tingling into the hand(s). The pain and numbness sensation patterns are often seen in the pinky and fourth digits but they can also affect the first three digits as well as the entire forearm and hand as well.
How is TOS diagnosed?
There is actually no gold standard orthopedic test to confirm the diagnosis of non-specific TOS, but instead practitioners will use a combination of the patient’s history and physical exam findings to confirm a suspicion of non-specific TOS. Those who work for prolonged hours in front of the computer or those who do prolonged overhead work are more likely to have TOS as they are compressing the thoracic outlet and irritating the nerves below. In fact, sleeping with your arm above your head can also be the culprit. And more often than not, these individuals will present with forward head position, rounded and/or shrugged shoulders and a rounded upper spine.
Treatment for non-specific Thoracic Outlet Syndrome (TOS)
Some techniques that may help include:
● Soft tissue therapy to overactive and overstressed muscles in the neck, chest and under the collar bone
● Joint mobilization including the rib joints and neck joints
● Trigger point release for those bound up muscle tissues
● Acupuncture to release the stress in the area
● Rehabilitative home exercises (stretches to tight muscles, strengthening/stabilization exercises, breathing exercises etc.)
How We Take Care of Your Thoracic Outlet Syndrome (TOS)
Hand numbness can be annoying, distressing and can disrupt all productivity in our daily lives. There are various types of reasons for hand numbness and knowing what could be the cause of it can aid in finding the right treatments to manage your symptoms.
With an integrated team of Chiropractors, Physiotherapists, Registered Massage Therapists, Acupuncturists and Kinesiologists, we have you covered for your Thoracic Outlet Syndrome problems.
Seeing different practitioners can be helpful as there may be various reasons for your head pains. Treatments in a multidisciplinary clinic can help address underlying issues from multiple aspects.
A combination of different treatments can include:
● Soft tissue manipulation to address muscle tightness and trigger points
● Stretching and exercise to manage the numbness symptoms
● Chiropractic adjustments to help with poor posture and creating space in the thoracic outlet
● Acupuncture and massage therapy to decrease stress on the nerves and blood vessel areas
● Ergonomic changes to your work setting to decrease load on the nerves in the thoracic outlet
If your condition does require further testing or treatment, we can refer you to one of the trusted specialists that we have in our network.
You don’t have to live with Thoracic Outlet Syndrome
The COVID-19 Pandemic has led many of us to adopt a hybrid working model or a complete switch to working at-home permanently. The inevitable amount of time spent at home in the past two years could have led you to some of these symptoms described above. Don’t hesitate to have your symptoms be assessed by any practitioner at Baseline Health and Wellness, your local Vancouver Wellness Clinic!Written by: Dr. Christy Yip, Vancouver Chiropractor
