What is Thoracic Outlet Syndrome (TOS)?
Nerve bundles coming out of spinal cord from neck can be compressed by muscles or narrowed bone structures. This space is called Thoracic Outlet comprised of scalene muscles, 1st rib and collar bone (Clavical bone). Once TOS occurs, it can result in numbness, strange sensation or pain in the same side arm, wrist and fingers.
How does it feel like (Sign and Symptom)?
- Numbness or tingling sensation in your arm, hand or fingers
- Feeling weakness or vibration after or while using your arm and hand
- Difficulty in fine movement with vibration(e.g. precise finger movement)
- Weakness in grip strength
- You can also feel neck, thoracic spine, shoulder or scapula area pain
What causes this symptom?
Nerve(Brachial plexus) and blood vessels towards your arm are interrupted by tight muscles and fascia surrounding it in its pathway.
- Tight muscles in neck and chest (Scalene, Pectoralis) compress the nerve bundle
- Trigger Points (Muscle Knot) increase radiating pain to forearm or hand
- Muscle imbalance around shoulder joint and scapula from poor exercise routine – TOS is common for young population doing chest based exercise routine with lack of stretching and back strengthening components
- Tight and stiff ribs and diaphragm can decrease circulation and increase tension on your chest and neck
How to treat TOS?
Release Trigger points and break up scar tissues in main muscle group. There are multiple trigger points in the main muscles.
Most important muscles are Pectoralis major and minor, Scalene, Infraspinatus, Teres minor, Subscapularis, Rhomboid
In addition to trigger point and scar tissue release, Long Time Stretch in Pectoralis Muscles, Scalene Muscles should be performed.
Improving Diaphragm and lower Rib Mobility can decrease tension in Thoracic Outlet by restoring normal breathing pattern with decreased scalene muscle tone.
- Long time stretch (longer than 2 minutes) using gravity is better than 10-15 seconds short time stretch method
Do sustained stretching in Pectoralis, Scalene muscles
- Trigger point release is more powerful than general massage
Find out trigger points in the main muscles and release it!
Pectoralis, scalene, rotator cuff muscles, rhomboid
- Balancing exercise program protocol
The mechanism of TOS is too strong and tight pectoralis muscles and relatively weak posterior deltoid, trapezius and rhomboid muscles. Balancing exercise program should focus on strengthening those weak muscle group. Once the strength of muscle groups are well balanced, scapula and shoulder joint are being placed in the ideal position.
What is the Best Treatment and Prognosis for TOS?
Most patients achieve significant relief and improved function within several weeks of treatment program.
Most effective method is a combination of Manual Therapy, Exercise Program, Posture Correction and Self Treatment method education.
- Manual Therapy is to break up the scar tissues on the main muscles to decrease nerve/ muscle tension.
- Trigger point should be performed prior to stretching to decrease tissue resistance.
- Static long time stretch of scalene and pectoralis muscles is very important and superior to short time stretching.
- Posture correction program has a long-term positive effect by improving awareness of good posture.
- By knowing and correcting your body pattern (e.g. You are shrugging your shoulder while driving or carrying your bag), you can change your old habit which was the one of the main source of your pain.