What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome is a condition where the neurovascular bundle (bundle of nerves and blood vessels) that travels down the arm are compressed, typically from a tight muscle or combination of muscles. This bundle starts in the neck and travels through the shoulder, down the arm and into the hand. Once compressed/irritated, pain/numbness/tingling may be experienced down the arm along the distribution of this bundle, often leading to frequent numbness in the hand. Symptoms can vary from mild to severe, with a frequent feeling of a hand or hands “falling asleep”.

Potential Causes of thoracic outlet syndrome include but are not limited to:

• Recent Trauma
• Previous Trauma
• Poor Posture
• Poor Sleeping Position
• Improper Ergonomics When Working
• Restricted/Altered Joint Motion
• Muscular Imbalance
• Muscular Weakness
• Repetitive Motion

Most Commonly, thoracic outlet syndrome is from tight musculature in the neck (scalene muscles) or chest (pectoral muscles) as a result of poor posture and/or flexibility.

Other tissues/structures in the body can mimic thoracic outlet syndrome, often leading to misdiagnosis and/or inappropriate treatments. Certain tissues, when irritated/Inflamed, can refer pain to different locations, called referral pain. An example of this is arm pain associated with a heart attack, the arm pain is not nerve pain, but referral pain from the heart itself.

Tissues/Structures that can cause pain down the arms/hands are:

• Carpal Tunnel/Ulnar Tunnel
• Cubital Tunnel
• Spinal Cord
• Spinal Nerve Roots
• Brachial Plexus
• Discs (Discogenic Referred Pain)
• Shoulder Joint
• Facet Joints
• Muscles (Trigger Points)
• Vascular Issues

Determining the cause of arm/hand pain is an important first step to ensure you receive the right treatment. Our doctors work hard to determine the cause of leg pain and come up with individualized treatment plans to reduce your pain as quickly as possible. Our doctors also work to decrease the risk of future flare-ups or additional problems from developing.

How is Thoracic Outlet Syndrome Diagnosed?

At CSMC, your first visit will start with a consultation and physical exam in order to determine which tissue/structure is causing your pain, how severe the condition is, what is causing the problem, and any contributing factors that may slow down or prevent proper healing.

This involves discussing your symptoms, when they are at their worst, the impact it is having on your life and putting together a set of treatment goals you would like to accomplish (examples: picking up kids or sleeping without pain). It is important to bring any previous medical notes or images for the doctor to review and take into consideration for your case.

Next, a physical exam will be performed, physical exams typically consist of:

• Neurological Evaluation
• Orthopedic Testing
• Postural Assessment
• Chiropractic Evaluation
• Functional Assessment
• Range of Motion Measurement
• Referral to Imaging/Advanced Diagnostic Testing (When Necessary)
• Radiographic Biomechanical Analysis (When Necessary)

These tests may aggravate your symptoms, so let your doctor know what you are feeling.

For imaging and additional testing, CSMC coordinates referrals to specialty radiologists and neurologists as needed.

What Treatments are Available?

CSMC takes a customized, comprehensive approach to care for all types of referral pain. Your doctor may recommend one or more of the following treatments to address your Thoracic Outlet Syndrome:

• Various Chiropractic Adjustment Techniques
  • Based on Preference/Condition
• Physiotherapy
• Ergonomic Training
• Massage Therapy
• Postural Correction
• Topical Analgesics
• Anti-Inflammatory Supplements

These therapies may be recommended individually or together to relieve your pain, decrease pressure on tissues/structures, improve your range of motion, restore muscular balance, improve posture and/or stabilize your condition depending on your needs.

For more severe/complicated cases, our doctors may decide to co-manage with another specialist to get a second opinion or additional treatments, such as medications, injections or surgery (last resort). In these cases, our doctors will communicate with all specialists involved to ensure all your doctors are on the same page, while providing therapies to help speed up your recovery process when appropriate.

You can find the help you need at CSMC. Book your appointment today.