The Thoracic Outlet Syndrome is a collection of symptoms caused by unhelpful shoulder posture. The shoulder blades become rigid and move around the shoulder from the spine toward the front rounding shoulder posture. This creates narrowing in the costoclavicular space (blue circle) where venous restriction can occur. The clavicle forms a base for the cervical spine and can lead to asymmetrical neck posture and even a side-ways rotation of the spine (scoliosis).
A second type of thoracic outlet restriction is within the scalene triangle where the brachial plexus can become entrapped creating a neuropathy down the arm, usually on the little finger side of the hand. This is known as the nerve type restriction. One might experience blotchy skin in the hands, whitening of the fingers, Raynaud’s and back of the head headaches.
The third type is a vascular restriction that can be found under the pec minor muscle that become foreshortened as the shoulder posture rounds forward. Usually this will give tingling in the hand and perhaps some grip difficulties from loss of power to writer’s cramp. The very astute may notice some sensation change in their mid-forearm, where sensation can become different to the rest of the forearm skin. (Musculo-cutaneous Nerve).
Trigger points within muscles around the neck and shoulders can compound either of the types described above making posture worsen and alter the pain experience. It is normal for those with TOS to have a variable experience to their symptom experience. It is important that Lee is able to apply his hands on therapy for you to ease the appropriate muscles and safely free the associated joints that cause restriction to the neurovascular bundle exiting the body into the arm.
The three types of Thoracic Outlet Syndrome are pictured below:
Neurogenic type in yellow circle, Vascular Type in Red circle and Venous type in blue circle
