Thoracic Outlet

Thoracic Outlet

Do you ever get numbness and tingling into the arms when sleeping at night, reaching overhead, brushing your hair, or driving your car? Well, there may be an explanation for that numbness sensation! It is called thoracic outlet syndrome and is quite common.

What is thoracic outlet syndrome (TOS)?

Did you know that directly under your collar bone is your first rib? Many people do not think about their ribs being that high up, but they are! A few muscles from our neck come down and attach onto that first rib. The muscles, the rib, and the collar bone create an outlet where nerves and blood vessels run through. Sometimes, those nerves and vessels can be pinched as they run through the outlet and create unpleasant sensations into our arms. When this happens, it is called thoracic outlet syndrome.

There are about three main types of TOS, however we are going to focus on the most common as it occurs in more than 90% of TOS cases. The most common form is called neurogenic thoracic outlet and occurs when the nerves coming directly from the neck are compressed within the outlet.

Common signs and symptoms

Some common signs and symptoms include:

  • Numbness and tingling into the arm, hands, and fingers
  • Shoulder and arm weakness
  • Arms that tire quickly
  • Muscle shrinking

What can cause TOS?

Here are the most common causes of TOS:

  • Tight muscles of the neck
    • Tension or increased muscle bulk can cause the outlet to have less space, resulting in those nerves getting pinched in the outlet.
  • Presence of a cervical rib
    • The first rib attaches to the first thoracic (mid-back) vertebra. Sometimes an extra rib can be present which attaches to the last cervical (neck) vertebra. That means the extra rib is too high and can pinch on those structures that run through the outlet.
  • Repetitive overhead movements
    • When our arms are raised to chest level or above, the outlet naturally becomes smaller. When this space is closed for a long period of time TOS symptoms can occur.

How is TOS diagnosed?

The tricky part of diagnosing TOS is determining what structure is causing the pinching and closing of the outlet. Numbness and tingling can occur for a variety of reasons and therefore, confirming the pinch is coming from within the outlet itself is of most importance. Ruling out other nerve entrapment conditions is important as some of the signs and symptoms are the same from one diagnosis to another. Various testing positions can help confirm TOS and determine what structure is causing the issue.

Sometimes an x-ray is warranted to confirm or deny the presence of an extra rib.

Treatment of TOS

There are various treatment options out there for TOS, depending on the found root of the issue.  When the issue is tight muscles or occupational/recreational repetitiveness, we are here to help!  Here at Miller Sports & Family Chiropractic, we offer:

  • Muscle work – getting those tight muscles to relax and quit pinching on the nerves as they exit the outlet
  • Chiropractic – proper alignment of the neck, upper back, and ribs can take tension off the nerves and muscles
  • Stretching/home rehab – stretching the tight muscles to reduce tightness will result in less pinching within the outlet

If a cervical rib is present, the above treatment options may be affective. Other times, more surgically invasive procedures may be considered to remove the extra rib.

If you are experiencing numbness and tingling, give us a call and let us do a full assessment to determine the cause! We have several treatment options to help reduce your symptoms and ultimately, get you just feeling better. Call us today!

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