Thoracic Outlet Syndrome
Sometimes symptoms in the arm and hand are actually due to a problem in the shoulder or chest. Thoracic Outlet Syndrome (TOS) is an example of this.
The thoracic outlet is the space at the top of the chest where nerves and blood vessels run to the arm. It is a tightly packed area, and can become a pinch point.
Symptoms
The classic symptoms of TOS are pins and needles in the forearm and hand. Depending on the exact presentation, you might mistake the symptoms for carpal tunnel syndrome. Your osteopath will be able to diagnose which one it is.
Pain or other sensations can also occur around the shoulder, where the original problem is. This might be a sharp pain or dull ache rather than the kind of pain felt in the arm itself.
Bony Anatomy and Thoracic Outlet Syndrome
Sometimes, TOS is caused by compression between the first rib and collar bone. Similarly, it can be the result of irritation by a cervical rib. Some people are born with an extra rib at the base of their neck, which may never be identified if asymptomatic. Family history can be relevant here, as cervical ribs can be inherited. If your family members suffer with symptoms of TOS in this case, you might be more like to as well.
If symptoms follow trauma, it is possible that a fractured bone could be involved. As these structures run close to the collar bone, which can displace when fractured, this should be considered. If your symptoms follow a potential fracture, you should go to hospital before seeing your osteopath.
Rounded Shoulders and TOS
Muscles on the chest can play a role in the development of TOS. The deep neck muscles and pectorals can compress the nerves and vessels involved. This can be either direct or indirect. If indirect, it may be the rounding of the shoulders themselves that cause the symptoms.
Many of us are stuck at our desks for long periods without appropriate breaks. The positions we sit in encourage the pectoral muscles to shorten, and the muscles around the shoulder blades to stretch and weaken. The muscular imbalance only allows the problems of rounded shoulders spiral. It is difficult to bring your shoulders back if the muscles that do so are not only weak, but also working against stronger muscles.
Active people are not immune to TOS either. Repetitive overhead throwing has been linked to cases of both neurological and vascular TOS.
Nerve vs Blood Vessel
The vast majority of cases involve a compressed nerve. Rarely, the cause is a pinched blood vessel. This comes with additional signs and symptoms:
The hand might feel cold to the touch
The hand may be pale or have a blue tint
The pulse might be diminished; this may be positional
Vascular thoracic outlet syndrome may require surgery and should be seen quickly by your doctor.
Osteopathy for Thoracic Outlet Syndrome
At your first appointment, your osteopath will work to diagnose your TOS and identify the factors that led to it. If the muscular problem mentioned above is true in your case, we will work with you to balance the muscles. This might mean a combination of hands on treatment and exercises to strengthen the back and stretch the chest.