Are you experiencing pain as well as numbness, tingling, and weakness in the hand and fingers?

These symptoms can result from various conditions: some of the more common ones include cervical radiculopathy and shoulder impingement syndrome, while the less common ones are brachial plexus injuries such as thoracic outlet syndrome.

What is Thoracic Outlet Syndrome?

The thoracic outlet is a space in the body that sits between the lower part of the neck and the collar bone. The thoracic outlet stretches to the upper part of the arm and contains a bundle of blood vessels and nerves that supply the arm. Thoracic Outlet Syndrome, later referred to as TOS, describes a series of conditions that cause compression of the major nerves and/or blood vessels that run through that thoracic outlet space.

There are three different types of thoracic outlet syndrome, and all of these are named after the type of vessel being compressed.

The most common type of TOS is neurogenic TOS which is caused by compression of the brachial plexus. The neurogenic type makes up about 90% of all TOS cases. Neurogenic TOS most commonly presents with slower onset of symptoms that include decreased sensation along the arm and possible weakness in the hand muscles.

Venous TOS is caused when the axillary or subclavian vein is being compressed in the thoracic outlet. Symptoms of venous TOS would be more abrupt in onset and includes venous distention in the neck and pain ranging from the arm to the forearm.

Arterial TOS is caused when the axillary or subclavian artery is being compressed in the thoracic outlet. Like the venous type, arterial TOS will also present with a more abrupt onset of symptoms, including color changes in the fingers and diminished pulses.



What structures can compress the neurovascular bundle in the thoracic outlet?

The compression of the neurovascular bundle in TOS can have multiple causes, ranging from anatomic anomalies to poor posture.

The first rib is the uppermost rib and projects off the first thoracic vertebrae. It is known that about 1 in 500 people present with a cervical rib, which is an anatomic anomaly where there is an extra rib that comes off the lowest cervical vertebrae. Cervical ribs have been identified to be a cause of neurovascular compression in TOS.

Another major cause of TOS is the tightness of muscles in the thoracic outlet such as the pectoralis minor and the scalene muscles.

Poor posture can be another cause of TOS. Slouched posture with forward rounding of the shoulder narrows down the thoracic outlet, which can compress any neurovascular structures.

Finally, TOS can be seen in athletes who engage in repetitive extreme shoulder motions such as competitive swimming or baseball pitchers identified to narrow the thoracic outlet.

How do we treat thoracic outlet syndrome?

In our Boca Raton Sports Chiropractic practice, we perform a detailed history of your injury, followed by a functional movement assessment and examination.

Mechanic causes of TOS such as poor posture or tightness of certain muscles respond well to conservative chiropractic treatment. More often than not, TOS will be caused due to a combination of tight muscles and poor posture. Tight muscles would be treated with a muscle release technique called Active Release Technique and Graston Technique. Poor posture will be addressed with sports rehabilitation exercises to strengthen the mid-back and deep neck flexor muscles.

Frequently Asked Questions (FAQ)

How do I know if a chiropractor is right for me? Do I need surgery?

At our chiropractic office, we take ample time to perform a detailed history and physical examination to find the cause of your pain. Once we have found the cause of your pain, we will develop a specific treatment plan that will suit your care.

In abrupt vascular symptoms such as diminished pulses, severe discoloration of the fingers, and cold hands, the patient will be sent out for an orthopedic consult to discuss surgical treatment.

With the absence of vascular symptoms, we would consider a conservative trial of care that includes releasing tight muscles, strengthening weak muscles to improve posture, and adjusting any restricted joints.

If a patient does not respond to a conservative management plan, the patient will also be sent out for an orthopedic consult to discuss possible surgical treatment.

A conservative treatment approach has fewer side effects than surgery and a faster return to normalcy than the extensive rehabilitation required after surgery.

How long will it take to recover from Thoracic Outlet Syndrome?

Unfortunately, this depends. According to the most recent research, an average conservative trial of care will take about eight visits, after which the symptoms will be re-assessed.

Recovery can be dependent on many things, including the body`s response to healing, lifestyle, ergonomics, and compliance to rehabilitation exercises. Depending on the severity of your symptoms, you may also need collaboration with other healthcare providers.

When should I see a chiropractor for my pain?

If you are dealing with any of the above-mentioned symptoms, we are here for you. If you want a same-day examination and treatment for your injury, call our Boca Raton office at 561-9978898 or schedule online.