Do you have pain, numbness and tingling down your arm to your fingers? Poor circulation in your arm, particularly when lifting? You could have Thoracic Outlet Syndrome.
This a group of disorders involving the compression of the brachial plexus, a bundle of nerves that branches down from the neck, under the clavicle (collar bone) to the armpit and down to the arm. Pressure here can cause compression of the nerves and or blood vessels supplying the arm and can be positional; caused by movement of the clavicle or shoulder girdle, or static; caused by abnormalities or enlargement of various muscles surrounding the arteries, veins and brachial plexus. It is most frequently caused by anomalies in the scalene muscles or enlargement (hypertrophy) of these muscles often from a motor vehicle accident.
Treatment can often be achieved with noninvasive procedures such as postural changes, stretching, massage therapy and chiropractic care. The recovery process can be a long term process and a few days of poor posture can often reverse progress that is being made in the treatment. 10 -15% of patients will undergo surgical treatment when conservative therapy has not been successful. This could include the removal of enlarged muscles, removal of one of the scalene muscles or the first rib and if present removal of a cervical rib.
Seeking massage therapy on an ongoing regular basis can loosen the muscles and adhesions in the area, opening up the underlying fascia to allow freedom of movement for muscles, blood vessels and nerves. It is important to follow your therapist’s recommendations for exercise, stretching and hydration between treatments to get the most benefit and long lasting results. By taking an active role in your health care you can avoid costly medications, invasive treatments and possibly surgery.
Things you can do to help your condition:
• Stretching:
The goal of self stretching is to relieve compression in the thoracic cavity, reduce blood vessel and nerve impingement, and realign the bones, muscles, ligaments, and tendons causing the problem.
o Moving shoulders forward (hunching) then back to neutral, followed by extending them back (arching) then back to neutral, followed by lifting shoulders then back to neutral.
o Tilting and extending neck opposite to the side of injury while keeping the injured arm down or wrapped around the back.
• Nerve Gliding:
o By performing nerve gliding exercises one can stretch and mobilize the nerve fibers.
o Extend your injured arm with fingers directly outwards to the side. Tilt your head to the other side, and/or turn your head to the other side. A gentle pulling feeling is generally felt throughout the injured side. Initially, only do this and repeat. Once this exercise has been mastered and no extreme pain is felt, begin stretching your fingers back. Repeat with different variations, tilting your hand up, backwards, or downwards.
• Posture:
TOS is rapidly aggravated by poor posture. Active breathing exercises and ergonomic desk setup can both help maintain active posture. Often the muscles in the back become weak due to prolonged (years) hunching.
• Ice/Heat
Ice can be used to decrease inflammation of sore or injured muscles. Heat can also aid in relieving sore muscles by improving circulation to them. While the whole arm generally feels painful, some relief can be seen when ice/heat is applied to the thoracic region (collar bone, armpit, or shoulder blades).
Please as always, consult with your healthcare provider if you have any questions about your health and before you start any exercise of self care activities. This article is not intended as a substitute for medical care in any way.
