Thoracic outlet syndrome

By Dr Guy Ashburner | April 19, 2018

Thoracic outlet syndrome

“Recent studies have shown that, in general, Thoracic Outlet Syndrome is more common in women than men, particularly among those with poor muscular development, poor posture or both.”

Thoracic outlet syndrome occurs when there is compression, injury, or irritation of the nerves (brachial plexus) and/or blood vessels (subclavian artery or vein) as they pass from the neck toward the armpit or upper arm through a space in the upper chest between the collar bone (clavicle) and the first rib.

Thoracic outlet syndrome symptoms may include feelings of heaviness, coldness, pins and needles, numbness and weakness/fatigue in your arm or hand. Pressure on the blood vessels can diminish the flow of blood to your arms and hands, making them feel cool and tire easily. Pressure on the nerves can cause an aching pain in your neck, shoulder, arm or hand. Symptoms vary, depending on which structures (nerves or blood vessels) are being compressed. Thoracic outlet syndrome can result from injury, disease, or a congenital abnormality (cervical rib). Poor posture and being overweight can aggravate the condition, which is more common in women than in men. It generally occurs in middle-aged women and almost always on one side of the body.

People most likely to develop thoracic outlet syndrome are those suffering traumatic neck and shoulder injuries from motor vehicle accidents, scrum collapse, falls, broken collar bone resulting in enlargement of the front neck (scalene) muscles and those who use computers, cell phones in non-ergonomic, poor postures (hunched over or drooping shoulders) and forward head postures, poor static postures for extended periods of time such as office workers, students.

Because the muscles that form this thoracic outlet canal are your accessory breathing muscles symptoms are most likely to occur during heavy exercise such as jogging or swimming. Shortening of these muscles is most frequently associated with habitual dysfunctional breathing associated with high stress, long-term smoking, chronic respiratory dysfunctions (asthma), overtraining in sport (swimming/athletics/heavy lifting) and chronic postural changes. Young overhead athletes (such as swimmers) and musicians may also develop thoracic outlet syndrome. Activities such as heavy lifting, combing one’s hair or carrying heavy bags or heavy shoulder loads on the affected side can aggravate symptoms.

Rounded shoulders and forward head posture force your scalene muscles on the sides of your neck to overwork and tighten up. The anterior and middle scalene muscles insert on to the first rib (originating from the neck bones), undue tension and shortening of these muscles will pull on and elevate your first rib which eventually causes nerves and blood vessels (neurovascular bundle)compression.

Osteopathy can help in the assessment, diagnosis and management of thoracic outlet syndrome. As part of the management plan the aim is to relieve the compression of the nerves and blood vessels within the thoracic outlet thus relieving and minimising pain. Treatment may begin with soft tissue work, articulation and neck stretching. Abdominal breathing, posture correction and postural strengthening exercises may be prescribed for the patients, as part of their overall management plan.


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