Thoracic Outlet Syndrome Exercise

Thoracic outlet syndrome is a condition where the neurovascular (nerves, blood) structures that service the arm get compressed outside of the spine (a peripheral neuropathy).   The compression can come the collarbone, the scalene muscles at the  base of the neck, an apical tumor or other mass.  Thoracic outlet syndrome can be unilateral (one side) or bilateral (both sides).

The brachial plexus is a bundle of nerves that eventually form the major nerves of the arm:  median, radial, and ulnar.  It passes directly underneath the center of the collarbone.  The subclavian artery, which becomes the brachial artery, is right next to it and supplies blood to the arm.  The collarbone (clavicle) connects your shoulder blade (scapula) to your breastbone (sternum).  There is only  a few millimeters clearance between the bottom of the collarbone and the ribcage, so proper alignment of these structures is absolutely critical for the nerves and blood vessels to work unobstructed.

Trauma to the shoulder complex, repetitive shoulder movements (like a baseball pitch), a long history of sleeping on your side, and a habit of carrying a heavy bag with a strap over your shoulder, or a history of carrying any other heavy objects on the shoulder such as a 5-gallon water bottle are some of the things that can cause the collarbone to close down on the neurovascular bundle.  Symptoms can include numbness down the arm; hand numbness,  arm and hand weakness, pins and needles sensation in the fingertips, and poor circulation in the arms (feeling of swelling or fullness).

A cervical rib can predispose one to thoracic outlet syndrome. A cervical rib is a congenital anomaly where a small rib branches from the lower neck vertebrae. A cervical rib can easily obstruct the brachial plexus on that side.

A syringomyelia or syrinx is a slowly expanding fluid filled sac in the spinal cord, usually at the neck level, that places dangerous pressure to the cord; enough to cause muscle atrophy (wasting) of the areas served by the affected neurons. Although syringomyelias are rare, they must be ruled out first.

If you are experiencing upper extremity numbness, see your doctor. You should get referred to an orthopedic specialist who can do some tests to properly diagnose your condition.    If thoracic outlet syndrome is suspected, your doctor may order a nerve conduction or needle electromyograph (EMG) study to determine if the nerve is compromised.  Typically, physical therapy is prescribed for several weeks.  If there is no improvement, surgery may be recommended.

The exercise below can be helpful for some sufferers of thoracic outlet syndrome, especially the type that involves the collarbone pressing down on the neurovascular bundle.  It is simple to do, and generally safe.  This exercise attempts to lift the collarbone repeatedly off the ribcage, creating more space for the brachial plexus and subclavian artery.  Do at least 100 per day for a week; if relief is felt, continue doing as needed.  If at any point your symptoms feel worse, stop immediately.

Exercise for Thoracic Outlet Syndrome

The thoracic outlet is an “opening” at the base of the neck, on both sides, where the nerves and artery that service the arm on that side exit through as they descend into the arm.  It is formed by the anterior and medial scalene muscles, the first rib, and the clavicle (collar bone).

If the thoracic outlet narrows in any way, due to one or more of these structures, neurovascular compression is possible (compression of the nerves and artery).  This can result in shoulder pain, neck pain, weakness in the affected arm and hand, numbness and tingling in the arm down to the hands, especially the last three fingers; and in some cases swelling of the arm.  Carrying something like a heavy bag on the affected shoulder makes the symptoms worse.

In thoracic outlet syndrome there is usually a history of prior injury/trauma to the shoulder girdle, such as a car accident or sports injury.  People with long necks and long arms are said to be more predisposed to this condition as the weight of the arm and length of the neck tend to put more stress in the thoracic outlet area.

Left alone without resolution, it is possible to develop permanent nerve damage resulting in chronic pain, weakness in the arm and hand, and reduced sensation in the inner arm area.

What to Do if You Suspect You Have Thoracic Outlet Syndrome

If you suspect you have thoracic outlet syndrome, see your doctor or an experienced chiropractor.  There are some simple orthopedic tests that can be done to see if you likely have TOS.  An MRI study can help visualize the thoracic outlet and identify if there is swelling; and needle electromyograph (EMG) can determine if the arm muscles are getting the proper amount of nerve flow.

If the diagnosis is confirmed, physical therapy exercises are usually prescribed to help open the thoracic outlet space.   In some cases, imaging studies show a fibrous band  responsible for compressing the neurovascular structure; in these cases surgery may be an option.  This involves the scalene muscles — three, short muscles that connect the lower neck vertebrae to the ribcage.

In the meantime, try doing this exercise.  It is designed to create more space between the collar bone and the ribcage.  If this is where your compression is occurring, it may help.

 

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