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Thoracic Outlet Syndrome


When evaluating a patient who has arm or hand tingling or weakness, it is important as a chiropractor to determine what the problem is being caused by. A lesser known culprit goes by the name “Thoracic Outlet Syndrome” (TOS). The thoracic outlet is an opening in the body, similar to the carpal tunnel that we have covered in the past. The floor of the thoracic outlet is made of your first rib and its associated connective tissue (fascia), the roof is made by your clavicle (collarbone) and a small muscle called the subclavius, the border to the front is another muscle called your anterior scalene, and to the back is your middle scalene (1). There are a few different forms of TOS. The most common form and the one we will spend some time discussing is called disputed neurological thoracic outlet syndrome (1). This differs from another form of TOS called true neurological TOS because the symptoms often do not meet the strict criteria for the true form (1).


When there is dysfunction present in one of the borders of the outlet, an increase in tension on both the vascular and neurological structures can occur. Either the anterior or middle scalene could be strained, or dysfunction of the sternoclavicular joint or the vertebrocostal joint at the first thoracic vertebrae could be present alone or in combination. Like most conditions, management should be dealt with conservatively first, and in TOS this is no different (2). From a chiropractic standpoint, TOS treatment would consist of adjustments to the lower cervical and upper thoracic spine in combination with myofascial release of the scalenes and other associated musculature (3). These therapies combined with exercises and stretches to help stabilize and strengthen the area have been shown to be an effective way to manage the symptoms of TOS (1,3). If you have been told you have TOS or think you may have something wrong with your arm that is not typical, reach out to us for an evaluation.



Diagram of the thoracic outlet with labels
Thoracic Outlet

Sources

  1. Lindgren, K.-A. (2010). Thoracic outlet syndrome. International Musculoskeletal Medicine, 32(1).

  2. Hooper, T., Denton, J., McGalliard, M., Brismée J.M., & Sizer Jr, P.S. (2010) Thoracic outlet syndrome: a controversial clinical condition. Part 2: nonsurgical and surgical management, Journal of Manual & Manipulative Therapy, 18(3), 132-138.

  3. Sucher BM. Ultrasonography-guided osteopathic manipulative treatment for a patient with thoracic outlet syndrome. J Am Osteopath Assoc. 2011 Sep;111(9):543-7. doi: 10.7556/jaoa.2011.111.9.543. PMID: 21955534.



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