Thoracic Outlet Syndrome (TOS) includes a group of conditions affecting one or all three major structures going into the arm from the spine:
- The brachial plexus nerves (median, ulnar and radial)
- The main vein (subclavian vein)
- The main artery (subclavian artery)
These structures pass behind the collar bone on their way into the arm.
The most common form of TOS, accounting for 95% of all cases, is Neurogenic TOS, meaning disorders produced by compression on one or all three nerves.
Venous TOS makes up about 4% of cases.
Arterial TOS is less than one percent of cases but is the most serious.
A person may feel a variety of symptoms such as pain, tingling and loss of circulation which may be there some of the time or all the time.
Nerve compression symptoms:
- Pins and needles in the hand often accompanied with pain
- Muscle wasting around the thumb
- Numbness on the back of the forearm
- Often severe pain in the neck
- Difficulty with fine finger movements
- Twitchy muscles in the arm
Venous compression symptoms:
- Painful, swollen or blue arm following strenuous activity to a large or small degree
Arterial compression symptoms:
- Arm looks white and blotchy especially when the arm is reaching away from the body
- Visual disturbance and dizziness
- Headache and nausea
Arterial compression is very rare but if you have had a fall or notice an unexpected change in the circulation to your arm then you should seek immediate medical attention and go to your nearest A&E for treatment.
In most people there is no obvious cause for the compression.
- An extra rib near the neck is found in about 1 in 100 of the population but not all of these people have symptoms related to TOS
- Occasionally it occurs after an injury to the shoulder or a whiplash injury
- TOS is frequently a repetitive stress injury (RSI) caused by certain types of work environments. Tade jobs such as electricians, plumbers and window cleaners are particularly at risk. Other groups which may develop TOS are athletes who frequently raise their arms above the head (such as swimmers, volleyball players, dancers, badminton players and weightlifters).
- TOS is also related to poor posture such as a forward head position common in office workers
- Posture correction: TOS is rapidly aggravated by poor posture so as a base for treatment correct posture is important
- Breathing exercises to expand the chest cavity and remove pressure from the affected structures
- Arm and hand exercises to maintain muscle balance
- Stretches to promote nerve gliding into the arm and hand
- Kinesiology taping to support the acromioclavicular joint in the shoulder
- Activity modification and risk assessment to remove the cause of the problem
Treatment is aimed at minimising the affects of repetitive motion and giving advise on the provoking activities until the condition settles.
More chronic problems may require medical management and a referral to a hospital consultant.
Please talk to our principal therapist at Hand Kinetics to discuss your specific needs and shoulder problem before making an appointment and we will be happy to discuss treatment options with you.
Hand Kinetics Telephone: 0044 28 417 72301
www.handkinetics.com
contactus@handkinetics.com
