The thoracic outlet of the human body is an area in which a group of nerves from the neck travel from their exit points of the neck and continues under and through the first rib and collarbone. There are also blood vessels that travel through the same pathway. The nerves, blood vessels or both can be compressed along this pathway. There are also muscles along the neck called the scalene muscles and some chest muscles, which may also cause compression of the nerves.
Regardless of the type of compression of the nerves and vascular tissue, you will experience symptoms into your arm. Some of the signs may be numbness and tingling as well as a diminished sensation of touch. There can also be pain and weakness. If more of the blood vessels are compressed, you may notice an increase in swelling and discoloration of the arm. This condition can mimic other conditions such as Carpal Tunnel Syndrome and/ or nerve compression at the level of the cervical spine. There are a variety of ways to diagnose and differentiate Thoracic Outlet Syndrome from other conditions. Some of them may include an electromyographic test (EMG), which can help reveal areas of nerve entrapment along the pathway of the nerve. CT scan and x-ray can also help in the diagnosis.
If you are suffering from this, you may feel that your hands are going to sleep or have pins and needles in them. You also may begin to feel that your arm and hand are clumsy and weak. There may be a dull, deep ache in your arm and hand. Sometimes these symptoms will occur early in the morning and may on occasion awaken you from sleep. Prolonged sitting may also aggravate the condition, especially if these positions are accompanied by activities where you are looking down or using your hands and arms. Prolonged posture, which includes your head flexed forward, shoulders drooped or rolled forward and tightened chest muscles will also add to your symptoms.
Treatment options for this condition may include:
- Chiropractic manipulation . Manipulation can help reduce the joint dysfunction that may be an added component of the pain. In the initial period your chiropractor will also use to use modalities, such as heat/ice or ultrasound, to help reduce muscle spasm and lessen referred arm pain.
- Massage. Massage can treat active trigger points in the muscle that are producing pain and spasm that could be closing the thoracic outlet
- Spinal Decompression or Cervical Traction. Traction on the head can help reduce pressure from the thoracic outlet. It does not work for everyone but is easy to do, and if effective the patient can use a home traction device.
- Physical therapy / exercise rehab . Poor posture can decrease the thoracic out let so strengthening core muscles will improve posture opening up the thoracic outlet.
- Activity modification. Some types of activities may tend to aggravated thoracic outlet syndrome. Decreasing or eliminating these activities sill help reduce the pain associated with thoracic outlet syndrome.
- Surgical – on rare occasions surgical intervention is used to try and open up the outlet.