Thoracic outlet syndrome

Thoracic outlet syndrome involves the compression of nerves and arteries as they pass between the anterior and middle scalene muscles in the neck.

The symptoms:

Thoracic outlet syndrome affects the nerves and the arteries passing into the hands and arms. If the compression is affecting the nervous system, then symptoms can include pain, numbness and tingling fingers, pain in the neck and shoulders, aching arms and hands or a weak grip.

If the compression is affecting the circulatory system, then you could see a discoloration of the hands or arms, a weak pulse or arm pain and swelling. These symptoms are caused by decreased blood flow into the arms through the subclavian vein and artery.

So what is going on?

The neck consists of seven vertebrae stacked one on top of the other. Small openings between the vertebrae allow for nerves to exit the spinal cord and into the body, in this case the arms. As the nerves leave the spinal cord, they form a web-like interchange, rather like criss crossing highways complete with exit ramps, called the brachial plexus. Two muscles extend down from the neck and attach to the first rib underneath the collar bone. These muscles, the anterior and middle scalenes, pass either side of the brachial plexus. The image shows the proximity of the scalene muscles to the brachial plexus and blood vessels

What causes it?

Muscles can become stressed and tense from continuous punishment. An example of this could be stress caused by a high paced desk job, where the person slumps into bad posture as the day goes by. It could also be caused by repetitive lifting of the arms and over-use of the wrists and arms, such as swimmers, rock climbers or weightlifters. It could also come about through trauma, such as a car accident causing damage to the clavicle.

What can be done?

The scalene muscles can be released using pressure techniques to the muscles in the neck. Often times, there will be a trigger point, a hard muscular knot, just under the clavicle, at the base of the front of the neck. This can be released using pressure into the trigger point until the point looses sensitivity. Mobilisation techniques can be used to restore movement to the neck, freeing the neck and allowing you to turn the head further than previously allowed. There may be cases where thoracic outlet syndrome is not caused by muscular tension. This may require surgery to alleviate. 

The thoracic spine

The thoracic spine is the middle section of the spine comprising of 12 vertebrae. It starts at the base of the neck, marked by a protruding vertebra, and meeting the lumbar spine just under the ribs.

There are 12 ribs, which attach to each of the thoracic vertebrae in the back and to the breast bone, or sternum in the front. Ribs 11 and 12 however, do not attach to the sternum, and are called floating ribs.

As with the cervical and lumbar sections of the spine, nerves emerge from the thoracic spine and proceed to various parts of the body depending on where in the thoracic spine they emerge. Most of the nerves run along the ribs of the rib cage. The nerves which emerge from the very top of the thoracic spine don’t, they supply the upper and lower parts of the arm, but more about them in later articles.

So what can go wrong with the thoracic spine:

The thoracic spine is fairly robust, but despite this, you could suffer anything from crush fractures resulting from a fall, to arthritis, slipped discs and dislocated ribs.

In this article I will focus on the most common complaint, muscle spasm caused by bad posture.

Enter the trapezius. The trapezius muscle is a large muscle which is shaped like a large kite. It attaches to the thoracic spine and up to the neck and out to the shoulders. It is coloured red in the diagram.

The muscle can be divided into three major sections, the upper, middle and lower trapezius.

The upper region of the muscle is responsible for lifting the shoulder blades, while the middle and lower regions pull the shoulders back and depress the shoulder blades downwards.

Now, your boss has been on your case for that report which is due by 5, and you have discovered that it needs a major re-write. You are stressed and you’re hunching. This pushes the neck forward and puts the upper fibres of the trapezius in a bad postural position. Do this over months, and the trapezius will form protective spasm, which hurt.

It isn’t just office workers who are affected, but sports people like cyclists who are hunched over handlebars all day or hair dressers who spend most of their days with their hands in the air.

Tense trapezius muscles can form tight bands of muscle in the shoulder and mid-back, causing pain. The middle fibres of the trapezius can also form trigger points, which refer their pain elsewhere, most often as a headache.

The good news is that this kind of thing is easily treated with specifically targeted deep tissue work and mobilisation of the thoracic spine.

Jacque Cilliers. Adv Dip. MT. (MSM)

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