Thoracic Outlet Syndrome: What Doctors Don't Always Tell You

What is TOS or Thoratic Outlet Syndrome? It's a collection of issues what causes pain or symptoms in the neck or upper limb area due to the pressure of the nerves or blood vessels. In a big picture, about 8% of the population experiences these symptoms most commonly in the dominant hand, around 81% of the case. The symptoms typically appear in individuals aged 20 to 50 with average age of onset at 40.

7 years. Unfortunately, symptoms are three to four times more common in women compared to the men. Here anatomical factors come into the play. Women typically have narrower space under the clavicular and the sternum may be lower, which in turn affects our accessory respiratory muscles, scaleneus muscles.

What risk factors might be behind these symptoms? Among the others, injuries such as whiplash injuries or fractures of the clavicle or ribs can increase the risk. These risk factors can be also divided into functional and structural categories. Functionally, the most common cause of the symptoms is the narrowing of the scaleneus muscles.

If there has not been regular exercises for the shoulder area, then the trapezius and the rhomboid muscle may be underactive, leading overactive activity in the scaleneus muscles, causing issues. Another cause could be forward head or shoulder posture. Functional factors like specific work-related stress can be also contributing to the symptoms. For example, forward-leading posture with the arm abducted or extended can cause the space between the clavicular and the first rib to narrow, compounded by the pressure from the pectoralis muscle.

In population, about 0. 5-0. 6% have extra rib. This additional rib originates from the lower cervical vertebrae, and if such an anatomical anomaly can be found, it's bilateral in 50-80% of the cases.

In other words, if there is an extra rib on one side, it's likely to have also at the other side too. An X-ray is a way to confirm this. Women are more likely to have extra rib with ratio to two to one compared to the men. If you work in industrial jobs or services professions, such as hairdressing, assembly lab work or cashier, your risk increases by 18%.

Additionally, musicians have their own set of challenges regarding to thoracic outlet syndrome. As there is many challenging postures and proper ergonomics in instrumental playing is crucial. Playing should be easy and low stress for the body. What are the typical symptoms if they affect on the veins or arteries?

The symptoms may include pallor of the upper limb, weak or absent pulse, numbness, tingling, pain or swelling in the hand or in the fingers area, as well as weakness in the neck or arm during the daily activities and unusual fatigue. It's also important to monitor any color changes in the hand and the fingers in the upper limb area. If individual nerves can't control the muscle at all, the muscle will start to utter if the nerve is functioning but weakly, the muscle control will be reduced and this will manifest as weakened grip strength. The upper limb may be cold or the skin may sense the touch, cold or heat in abnormal way.

Typical nerve related symptoms include tingling, numbness or shock like sensations. According to the article in Duodecim, muscular related symptoms account about 5 to 10 percent of the cases. The majority of the symptoms are nerve related, approximately 90 to 97 percent, with only 1 percent of those being true nerve related symptoms. These remaining 90 percent of the cases are non-specific symptoms, meaning that the precise cause of the symptoms cannot be identified.

However, it's important to remember where the symptoms are located. If the symptoms are felt in medial nerve area, they typically affect inner surface of the thumb, index finger and middle finger. If the symptoms are more in ring finger and little finger, then it's likely to be ulnar nerve. If the symptoms are more in the back of the thumb, index and middle finger, it's likely to be radial nerve.

Everyone has a thoracic gauge, 12 pairs of the ribs and with the two lowest beam floating ribs. Generally speaking, if I check the movement of the thoracic spine in the clinic, I ask the patient to cross the arms at the shoulder, start with the side bends, then to the rotation and then to the back bends. If there is a significant stiffness, some form of test, treatment and home exercise is necessary. In my channel, you can find good exercise for the chest spine mobility and if you like this content, feel free to subscribe to the channel.

It means a lot to me. What else needs to be checked in the thoracic cage? Well, the uppermost ribs and their movement. This is done by using the head rotation and side bend test.

The chin is rotated towards the shoulder and the hand is bent to the side towards the thoracic gauge. If the movement stops immediately, the uppermost ribs may be elevated causing movement restrictions in the upper thoracic spine. The medial nerve is the most common nerve entrapment in the upper limb area originating from C6, C7 and T1 levels in the cervical spine. Considering all upper limb nerve symptoms, this nerve is accounted for the 70% of the cases.

You can find the video related to this nerve in recommendation at the end of the video. The ulnar nerve is the second most common nerve entrapment originating from the C8 nerve's root and the T1 level at the chest spine. This accounts about 20% of the upper limb nerve symptoms. This video will be recommended after you check the first one, the medial nerve.

The radial nerve is the rarest nerve entrapment accounting about 10% of the upper limb nerve entrapments which roots are originating from the C5, C6, C7 and C8 levels. This video will be a recommendation after the ulnar nerve video. So it's definitely worth checking out this information package if you are experiencing nerve related issues. Here is a general overview of this topic.

In the next video, we'll go over the important anatomical factors in more detail and what on earth you should do with them. It will be recommended here once it's ready. Thank you very much for your time and see you at the next one.