Chirolink has seen a steady stream of patients coming in with thoracic outlet syndrome throughout the years. It’s a relatively common condition but it tends to worry a lot of people – the symptoms can overlap with those of more serious conditions (particularly when you ask Google). We are here to tell you not to worry. It’s part of our job at Chirolink to keep our patients informed and educated and to put their minds at ease.
Let’s start with the symptoms:
- Neck and shoulder pain can also refer down the arm.
- Numbness or pins and needles along the arm or hand.
- Cold hand or fingers.
- Venous engorgement or slight swelling of the hand.
- Possible weakness in the hand or forearm.
- These symptoms can affect one side or both sides of the body.
What is the thoracic outlet?
This is the part of the body between the neck and the upper thorax. It is the ring/hole at the very top of your ribcage. This is a very small area for many structures to go through. The focal area we consider concerning thoracic outlet syndrome is the space between the first rib at the back and the clavicle (collarbone)at the front. Every structure is intricately placed and functions in a safe, comfortable state of homeostasis. There are major blood vessels, nerves, lymphatics, and even ligaments, muscles, and their tendons occupying this space. Normally, there is enough space for these contents to function together optimally but because it is so small when something else takes up this space, you can feel it.
What is thoracic outlet syndrome?
Thoracic outlet syndrome is characterized by compression of the brachial plexus, subclavian artery, vein, and surrounding lymphatic vessels. These are all thick, strong, and resilient structures and can withstand a fair amount of stress – but when this is prolonged or too intense, they tend to get aggravated which results in the symptoms we discussed above.
What causes this compression?
Various structures can cause compression. These include:
- Pectoralis minor muscle spasm.
- This is generally the ‘poor posture’ muscle. When we sit (especially with our shoulders rounded forward) for too long, which is most of us, this muscle tightens and shortens. The pectoralis minor muscle sits directly on top of the brachial plexus and subclavian vasculature as it reaches over and attaches to the scapula so when it tightens, it compresses them.
- Scalene (anterior, middle, or posterior) muscle spasm.
- These are generally the ‘stress’ muscles. When we stress, we take shallow breaths. This means we are not using our diaphragm to breathe but use our accessory breathing muscles (such as scalenes). Because we are all so chronically stressed, these muscles tend to overwork, and therefore tighten and shorten. The scalene muscles also sit directly on top of the brachial plexus and subclavian vasculature, just higher up into the neck, so when they tighten, they compress them.
- Either a costoclavicular syndrome or a first rib restriction.
- This is either when the clavicle (collar bone) is compressed downwards towards the first rib or when the first rib is restricted in movement and is pulled upwards where the brachial plexus and subclavian vessels pass between. The collar bone is often compressed by a handbag or backpack and the first rib is often pulled up by the subclavius muscle (another accessory breathing muscle that tightens with stress but poor posture too).
- Cervical rib or space-occupying lesion.
- Some of us are born with variations. One of these variations can be an extra rib that sits at the bottom of the neck. This can compress and irritate the brachial plexus and subclavian vessels and it may only occur as we get older as the bones and cartilage become less supple.
- A space-occupying lesion such as an enlarged lymph node or tumorous growth can also compress these structures, but this rarely occurs.
Our bodies are intelligent. When things start to change, the body adapts exceptionally quickly. We tend to keep doing what we’re doing (such as poor posture) because we aren’t yet experiencing pain, but this system can only hold for so long. This is why thoracic outlet syndrome often has a gradual onset. The compressed structures are resilient enough to handle the stress they are under for a fair amount of time, but eventually, as it progresses, you feel the effects.
How do we treat this?
There are various tests that we as practitioners can do to determine the cause of the symptoms that patients are experiencing and at Chirolink we find patients respond exceptionally well to Chiropractic adjustments of the impacted joints and trigger point release of the associated muscles. This mechanically allows the entire upper thoracic system to function optimally, reducing any pressure on the nerves and vasculature.
Postural exercises are vital for this condition. The body needs to learn a new normal when it comes to the position of the affected muscles. Yes, the body is resilient and adaptable and the affected muscles may try to adapt for a while but eventually, it shouts for help be it the first, second, or third time it comes around. Coming for regular treatment and consistently doing the right exercises will see long-term results.
- Shoulder rolls and wall angels – this assists to rotate those scapulae back down that have chronically been pulled forward by the pectoralis minor.
- Stretch the affected muscles. Lengthen them out. This will allow optimal movement and less tension on all the surrounding structures.
- At Chirolink we can assist you with the appropriate exercises and stretches that need to be done.
Stress management and breathing exercises are non-negotiable with thoracic outlet syndrome. The better we manage our stress, and breathe with the diaphragm, the less likely it is for the accessory breathing muscles to overwork and cause compression of the neurovasculature.
Take a look at our blog post about Applied Kinesiology. This provides some excellent tools to stimulate the vagus nerve allowing us to downregulate the nervous system with proper breathing and release of tension in associated muscle tension.
As you’ve seen in a number of our blog posts, magnesium, and vitamin D supplementation shouldn’t be neglected. They both allow optimal muscle function but also allows the body to process stress chemicals properly and break the stress cycle which is incredibly vital with this condition. A vitamin B complex can also be taken to ensure optimal nerve function. When nerves are unhappy or misfiring – the first point of call is vitamin B.
As it is with anything, commitment, and consistency are key for any treatment to be truly effective. We cannot go to the gym once or eat healthily for one day and expect to have a perfectly strong, fit, and healthy body. Thoracic outlet syndrome is a completely manageable condition that you need not suffer with. Give us a call at Chirolink and we will be more than happy to assist you.