Stuart Hinds demonstrates assessment and treatment of interface restrictions in Thoracic Outlet Syndrome (TOS).
"Thoracic Outlet Syndrome (TOS) is a frequently overlooked peripheral nerve compression or tension event that is often difficult to diagnose, but it can often respond surprisingly fast to manual therapy."
Thoracic Outlet Syndrome, or TOS, occurs when nerves and/or blood vessels become compressed in their passageway through the thoracic outlet which sits between your collarbone and first rib.
The thoracic outlet is surrounded by bone, muscle and other tissues. Movement or enlargement of these tissues near the thoracic outlet as a result of conditions such as cervical rib, tumours in the chest, muscle enlargement and weight gain, may lead to TOS.
These conditions may cause the collarbone to slip putting pressure on the blood vessels and nerves that sit underneath it leading to TOS.
Thoracic Outlet Syndrome Awareness
TOS is one of a group of conditions that cause pain in the arm, hand and fingers.
Not everyone is aware of TOS and it's not unusual for clients to work their way through a number of visits to doctors and therapists by the time they receive a confirmed TOS diagnosis.
Types of Thoracic Outlet Syndrome
The symptoms of TOS can be really disturbing and cause much anxiety (which doesn’t help).
There are generally two types of TOS – one is an unmistakable blockage pressure (organic) to the nerves or blood supply and the other is a functional or temporary pressure issue.
This functional group tends to respond very well to trigger point self-help techniques.
That’s because functional TOS results from a combination of poor rib mechanics and tight muscles (especially the scalenes and pectoralis minor) that cause pressure on the neurovascular structures (sometimes called a myogenic plexopathy).
What Are the Symptoms of Thoracic Outlet Syndrome?
This will depend on the blood vessels or nerves that are compressed. It is more common to have symptoms from nerve compression than from blood vessel compression.
- Both types of compression may make overhead activities difficult.
- Discolouration or swelling in your arm
- Depression in your shoulder.
- Limited range-of-motion.
- Redness or swelling of the arm due to a reduction in the blood flow from pressure on the blood vessels. Symptoms may also be felt in the arm and hand.
- A dull ache from nerve pressure may be felt in the hand, arm, shoulder or neck. Tingling, pain or numbness may also be felt on the inside of the forearm and 4th and 5th fingers. The hand may feel clumsy.
Who is Prone to Thoracic Outlet Syndrome?
- Physically active, younger adults whose occupations involve a repetitive raising of the arms, e.g. machine operators, truck drivers and dental workers
- Those born with an extra rib (known as a cervical rib)
- Those with a deformity caused by a fracture to the first rib or collarbone
- Weightlifters (due to enlargement of a muscle)
- Sagging of the shoulders due to older age
Differential Diagnosis - What Else Could It Be?
Here is a list of other conditions which may present similarly to Thoracic Outlet Syndrome; some of these can be serious, so if you are concerned please check with your doctor or therapist.
Extra cervical rib or ligamentous (false) rib
Brachial plexopathy (infective or traumatic)
Soft-tissue damage (from whiplash)
Heart attack (left side)
Vertebral Artery Disease or an aneurysm
Hyperkyphosis or Scoliosis of the thoracic spine
Degenerative changes in the neck (cervical bars and osteophytes)
Complex Regional Pain Syndrome 1 (CRPS1) - RSD
Problems with the neck including discs and spinal joints (age-related)
Thoracic Outlet Syndrome and Trigger Point Therapy
Trigger points can develop in muscles for a number of reasons, especially overuse.
When present, trigger points cause the host muscle to be shorter, tighter and tenser and they also add to the cycle of increased input to the peripheral and central nervous system.
With TOS, the results of trigger point therapy can be startlingly fast; will almost always provide relief; and accelerate well being.
As is usually the case with trigger point therapy, the hands-on treatment is likely to be most effective when combined with correct stretching and strengthening exercises.
When treating TOS, these typically include neck stretching, ulnar glides, upper trapezius and pectoralis stretching, back mobilization, and rhomboid strengthening.
Self-treatment with pressure tools can also be very effective. See examples below:
Self Help - Subclavius
Self Help - Infraspinatus
Self Help - Infraspinatus
Self Help - Pectoralis Minor
About the author
Stuart Hinds is one of Australia’s leading soft tissue therapists, with over 27 years of experience as a practitioner, working with elite sports athletes, supporting Olympic teams, educating and mentoring others as well as running a highly successful clinic in Geelong.
Stuart has a strong following of practitioners across Australia and globally who tap into his expertise as a soft-tissue specialist. He delivers a range of highly sought after seminars across Australia, supported by online videos, webinars and one-on-one mentoring to help support his colleagues to build successful businesses.
In 2016, Stuart was awarded a lifetime membership to Massage & Myotherapy Australia for his significant support and contribution to the industry.
This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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- Tags: Elbow, Shoulder, Thoracic Outlet Syndrome, TOS, Treating Elbow Pain, Trigger Point Therapy