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Thoracic Outlet Syndrome

The thoracic outlet (also, confusingly, called the thoracic inlet) is located where the chest meets the arm. Here, blood vessels and nerves pass through small spaces on their way to the arm, or back to the chest. If they are compressed, you may develop symptoms into the arm or shoulder.

Thoracic Inlet

Symptoms of Thoracic Outlet Syndrome

When a nerve is irritated, pain might take the form of:

  1. pins and needles

  2. sharp or shooting pain

  3. numbness

Pain often follows the nerve directly, in a defined line. Sometimes the pattern is more vague.

There may also be weakness in the arm, or if blood vessels are compromised, discolouration of the arm or hand. Your osteopath can test your pulse and other changes in a position that puts more strain on the area to identify whether you have TOS.

Vascular vs Neurogenic TOS

There are a few defining features to set the two types of thoracic outlet syndrome apart. This is important, as vascular TOS, although more rare than neurological TOS, needs quick medical attention as decompressive surgery may be necessary.

One key sign of vascular TOS is disruption to pulses in the arm. Your osteopath will test for this by monitoring the pulse at the wrist and stressing the outlet. If the pulse becomes weaker, a referral is necessary. You might also notice that your hand becomes cold or discoloured when the shoulder is aggravated.

Cervical Ribs Causing Thoracic Outlet Syndrome

Some people are born with an extra rib or pair of ribs. They most commonly affect the lowest vertebra in the neck, and often go unnoticed. However, they can put extra pressure on the thoracic outlet and lead to TOS. These are called cervical ribs, which literally means “neck ribs”. Cervical ribs are rare, but if they cause TOS then surgery may be the most appropriate solution.

Managing TOS

As mentioned above, vascular TOS should be referred swiftly to a doctor. For neurological cases, osteopathic treatment has been shown to be effective. Fortunately, about 80% of TOS cases are neurogenic, so you may find it quickest to see your osteopath first if you cannot get in with your GP quickly, and do not show the above signs of vascular TOS.

Osteopathic treatment may involve work to the local muscles, whether they are a direct cause of the TOS or otherwise involved. Sometimes the outlet is compressed by rounded shoulders. In this case, work to strengthen the upper back and encourage the shoulders backwards can be useful. This may be associated with an unsuitable desk set up. We can offer advice in this area too. There is no one-size-fits-all in ergonomics, and given your complaint, we can suggest small changes that prioritise your shoulder and upper back positioning.

In any case, your osteopath will look at your problem as a whole, and how it relates to the rest of your body. The treatment plan and any advice will take this into account, and address the situation in its entirity.


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