Thoracic Outlet Syndrome (TOS)

Thoracic outlet syndrome (TOS) has a wide range of symptoms, and can be confused with cervical radiculopathy – “a pinched nerve in your neck.”  Symptoms include pain or numbness, which may affect the pinky and outside of the hand, or may spread to the whole hand and arm.  Pain may also affect the area below your collar bone, your armpit or the area in between your shoulder blades. 

You may also find that one of your hands is swollen for no apparent reason.  The swelling is usually worse when you wake up in the morning.  You may also notice discoloration or coldness in the affected hand.  You may also notice that your hand or arm feels weak or uncoordinated.

So what is TOS?

Thoracic outlet syndrome happens when the nerves and / or blood vessels to the arm get compressed (“squished”, “pinched”) near where they leave the neck.  There is a little triangle in the side of your neck where the brachial plexus, a bundle of nerves that goes to your arm  and the subclavian artery that feeds your arm have to pass through.  The triangle is made up of two muscles, the anterior scalene and medial scalene.  The first rib is the bottom of the triangle. 

When the scalene muscles are tight, they can pull the first rib upward.  This makes the triangle smaller and can compress the nerves and the artery.  A small percentage of people also have an extra rib that makes the triangle smaller, too. 

After the nerves and artery go between the scalenes and the rib, they have to between the collar bone and the rib cage.  Unfortunately, they can get pinched here, too.  Lots of things can cause this.  If the scalenes are tight, they can lift the first rib up against the collar bone.  There is also a little muscle called the subclavius that stabilizes the collar bone.  When it is tight, it can also pull the collar bone against the rib and compress the nerves and blood vessels.  Poor posture with slumped, rounded shoulders can also contribute to nerve compression here.

What Can Cause Scalenes (and other muscles) to be Tight?

One of the most common causes that I see are whiplash injuries.  Whiplash is associated with sudden extension of the neck, like what happens when you are rear-ended in a car.  This puts a sudden strain on your neck muscles.  Other things, like stress, poor posture, chest breathing, excessive coughing and exercises like farmer carries can also cause your scalenes to tighten up.

What’s more, muscles in your neck and shoulder girdle can form trigger points that can mimic the symptoms of TOS.  What are trigger points?  Trigger points are sore spots in tight bands in your muscles. Normally, they shouldn’t be there. Injury, infections, stress, over training and about a hundred other things can cause them to form. They’re different from regular tight muscles. Trigger points are basically little inflammation factories. What’s even weirder, trigger points can cause pain and other symptoms in totally different parts of the body – away from where the real problem is.

The Good News

A careful physical exam and imaging will help determine if your symptoms are due to tight muscles or related trigger points and rule out structural issues, like disc bulges or an extra rib.  When symptoms of TOS are due to tight muscles or trigger points, they usually respond well to dry needling acupuncture.   

When you come in for your appointment, we will take a history, do a physical exam and help rule out more serious problems.  We’ll examine your posture to see what muscles might be weak and which other ones are tight.  We’ll also check for trigger points that could be referring pain to your arm or compressing nerves. The advanced Orthopedic Acupuncture & Dry Needling styles that we use are ideally suited to reset dysfunctional muscles, reduce neurogenic inflammation and help restore normal function.  We’ll create an individualized treatment plan for you to help reduce your pain level, improve your quality of life and help you get back to doing what you love.