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Thoracic Outlet Syndrome

Hello readers and welcome to our July 2020 blog. This month we’re discussing a condition that can affect the whole arm, from the neck, down to the tips of your fingers. Welcome to the world of Thoracic Outlet Syndrome (aka ‘TOS’).

What is TOS?

TOS is an umbrella term for a group of conditions that are caused by compression of nerves and blood vessels as they pass from the neck, through the shoulder and down the arm towards the hand. The thoracic outlet (also referred to as the thoracic inlet, just to be confusing!), is located at the top of the rib cage, where the shoulder meets the neck. It is basically a hole created by a ring of bone and tissue, through which certain nerves and blood vessels run through. Several things can go wrong, which can lead to these structures becoming compressed.

Types of TOS and common symptoms

There are three main types of TOS. These are:

Nerve-related TOS: This equates to 95% of all incidences of TOS. Nerve compression in the shoulder region can cause pins and needles or numbness of the hands and fingers, aches and pains in the neck, shoulder and armpit region, as well as changes in the colour of your hand as well as making your hand cold. Long term nerve-related TOS can lead to muscle wasting in the hands.

Vein-related TOS: This equates to 4% of all incidences of TOS. Compression of the main vein can cause pale skin colour, coldness of the limb, swelling of the fingers and arm, weakness of the arm as well as pins and needles and numbness.

Artery-related TOS: This equates to 1% of all incidences of TOS. Compression of the main artery can cause colour and temperature changes in the hands and fingers, swelling, pins and needles, reduced blood circulation and heaviness of the arm, hands and fingers.

There is quite a bit of overlap in symptoms from type to type, so it can be difficult to get an accurate diagnosis in the early stages. Fear not, we are trained to recognise these conditions, and we are well versed in how to test for them!

Causes

There are many different things that can lead to the development of TOS symptoms. In simple terms, anything that leads to the closing of the thoracic outlet hole can cause TOS. Some of the known causes include:

A chronic poor posture of rounded, drooping shoulders

An elevated 1st rib

A depressed (or fractured) collar bone

Tight scalene muscles in the neck

Tight pec muscles (specifically the ‘pec minor’ muscle)

Cervical ribs (a rare phenomenon whereby a person has an extra rib that attaches to the bottom neck vertebrae, just above where the normal rib cage sits)

Tumours that grow into the space

Repetitive overhead/overarm throwing sports

Treatment

Treatment focuses on the cause. If the cause is posture-related with tight muscles leading the way, then techniques aimed at relaxing the muscles, as well as exercises to improve droopy posture, are the way forward. It might sound silly, but we will educate you on how to stand, sit and lie down to ensure you are not compromising your posture and feeding the problem more.

The shoulder blade is commonly a problem area that needs some TLC with this condition. If the position of the shoulder blade is causing the thoracic outlet to become compromised, then exercises to improve shoulder blade positioning and stabilisation exercises can be very helpful.

If someone has a bony abnormality, like a cervical rib, that is causing the symptoms, then a specialist's opinion may well be required. Some severe forms may require surgery in order to resolve the symptoms. This is very rare and is only ever carried out if all other treatment pathways have failed. If the nerve and blood supply of the limb is reduced over a long period, this can lead to long term complications with the health and function of the tissues in the limb.

Our advice to you

If the picture we have painted above sounds remarkably like what you are experiencing, then help is at hand. Please call us today on 0413 774 399 and book your appointment now.

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© 2018 Dr. Claire Chittleborough

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