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  • Michael Salcido

Thoracic Outlet Syndrome

The Cervical Spine is comprised of many tissues working in harmony to maintain stability of the skull. The skull itself can weigh up to 10lbs! That is pretty heavy. the skull is placed upon a small fulcrum to rest and rotate. The muscles of the neck and cervical spine are tasked with not only the mobile functionality of the head at the 1st vertebrae but also the stability.


All day the neck muscles of the cervical spine are holding this large mass of bone and brain perfectly level. The complexity of simply keeping the head level is a challenge in and of itself. The harmonic task of these muscles, tendons and ligaments are faced with plenty of biomechanical challenges that could be faced with extra stressors from the exertion of so much energy.


Where Energy is converted into work muscles are put through strenuous activity. The Strenuous activity converts itself into possible hypertone and Trigger Points. The Hypertone and Trigger points contribute to the pressure or compression on various Arterial, Venous and Nerve structures. These contributing factors create the syndrome.


In this particular case of Thoracic Outlet Syndrome (TOS) the brachial plexus is more likely to be the compressed nerve tissue, and furthermore the medial nerve that extends from the brachial plexus.


TOS can definitely place blame on postural distortion or dysfunctions, faulty ergonomics, overuse and stress. In rare cases the TOS is related to Trauma or genetics. Luckily Massage Therapy plays a very important role to the possible recovery and rehabilitation of TOS.


TOS can be categorized into 4 different Pathologies.


1. True Neurological TOS, which is created from a genetic disorder. An extra rib, unusual and rare that pinches up against the nerve plexus.


2. Anterior Scalene Syndrome: The nerve compresses the anterior and middle scalene muscles.


3. Costoclavicular Syndrome: Nerve compressed between clavicle and first rib.


4. Pectoralis Minor Syndrome: Nerve compressed between the pecs and upper ribs.


TOS can ignite a variety of symptoms typically related to both Nerve compression and circulatory disorders: Paresthesia, heavy upper limb, coldness, discoloration, aching, and muscular atrophy.


I have had clients that develop these symptoms, a similar pattern arises in the descriptions given: "it feels like my arm is dying." . which is a great, yet macabre way to describe it. The arm is cut off from both nerve and circulation.


As common as this Syndrome is, it is just as simple to get under control. Well except for True TOS. That requires expertise beyond massage, physio or Chiropractic. Other wise TOS comes along with some form of Upper Body Dysfunction. But for specific release of TOS it is recommended to release all the muscles along the nerve pathway but specifically releasing:


  1. Pectoralis Minor

  2. Latissimus Dorsi

  3. Teres Major

  4. Subscap

  5. anterior scalenes

  6. Subclav

  7. Anterior Oblique Subsystem ( Series of muscles related to UBD)

Until Therapeutic Massage intervention and rehabilitation one can stretch the various muscles listed above. Most important stretch will be the chest stretch and upper body twist while laying on the ground.


  1. Lay on your side knees bent and hips flex knees side by side

  2. Take your right hand and place it atop the left knee

  3. Take your left hand place it behind your head, take the same elbow and place it close to the floor just enough to feel a stretch behind the shoulder (Posterior Deltoid).

  4. Now open up your chest by bringing your left elbow to the other side of your body.

  5. You should only hold this stretch for 10 to fifteen seconds.

  6. Repeat on the other side.

A modification to the stretch is looking away from the elbow after the twist to stretch the scalenes. Another important stretch is the child's pose. This will help open up the latissimus dorsi.


If you feel as if any of these symptoms are related to you in anyway give me a call or book today. It doesn't take as long as you think to recover from TOS.


Thanks for Reading.


Michael.

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