Thoracic Outlet Syndrome–TOS, for short

When it first began with shoulder and upper back, I thought it was just muscular tension from leaning over the computer or patients as I’m doing acupuncture. But as the initial pain resolved and the throbbing pain moved to my forearm, I knew what it was. Thoracic outlet syndrome. 

Unfortunately, I was on my way to a week long yoga/surf retreat, so there was little I could do to address it immediately. The forearm pain progressed to tingling and numbness in my fingers, so sitting still in meditation or savasana (corpse pose–lying down on back and remaining still) was really a struggle. I one-handed some of the yoga poses and skipped out on others. Surfing and paddle boarding were a bit of a challenge, but workable. Perhaps it aggravated my TOS since the numbness persists, but at least now the pain is gone.

Isn’t it interesting though that once you experience something yourself, you seem to draw in others experiencing the same? Such is the case for me in my practice, so I thought I would blog about thoracic outlet syndrome, so you can know if maybe you or someone you know has the same.

What is thoracic outlet syndrome?

TOS is a condition caused by compression of the nerves, blood vessels, or both as they pass through a narrow area between the base of the neck and the armpit, called the thoracic outlet (makes sense). It’s kind of like the more commonly recognized carpal tunnel syndrome, except where the arm meets the torso instead of at the wrist. 

How it thoracic outlet syndrome diagnosed?

First, symptoms are considered. Do you have:

• neck, shoulder, or arm pain
• numbness or tingling in the fingers
• weakness in the hand
• impaired circulation to your hands and fingers
• redness or swelling in your arm
• hands or arms that are easily fatigued

If you have those, you can try out this the Roos test. Raise your arms by your sides and bend at your elbows 90 degrees, hands facing front. Quickly open and close your hands for up to two minutes. If the affected side feels worse than the non-affected side, reproducing your symptoms, then you may have TOS.

You can also get electrical and radiological tests.

What causes thoracic outlet syndrome?

The thoracic outlet really doesn’t leave much space for the blood vessels and nerves to pass through, so anything that causes compression on them can result in TOS. I mentioned that mine is predominantly tight pecs minor muscle. But it could also be tightness or inflammation in the scalene muscles (along the side of the neck) or an extra rib called a cervical rib.

My thoracic outlet syndrome was from carrying one dog in a front body carrier while walking my other dog who sometimes pulls me forward (my first and only time doing that). I wish I could say it was from doing something amazing like a one-handed handstand or saving someone’s life, but sadly, it wasn’t. 

You might also get it from an imbalance of strong chest muscles to upper back muscles, improper weight lifting, impact injury, repetitive movements, poor posture, obesity, or just that you happen to be born with a cervical rib.

What can you do about thoracic outlet syndrome?

Stretching is helpful. Check out this video for a few stretching options. Stretching the neck and the chest helps open up more space for the structures to pass through the thoracic outlet. Balancing that with strengthening exercises to help pull the shoulders back and position the head better over the torso are also helpful. 

I use a rolled up yoga mat to lie on (place it between your shoulder blades and stretch your arms out to your sides or over your head), but you can also use a rolled up towel, blanket, or sheets. Or, another option might be to do a Zipline and stretch out this way! Not exactly practical, but definitely more fun! 😉

What I find most helpful is acupuncture. While I was at the retreat, I was unable to get someone to acupuncture me and I was unable to acupuncture my own shoulder, pecs, and back, so I did a very simple forearm treatment (shown partially completed above) that helped. Oh, and kinesiotaping to support the muscles. That really helped in between the acupuncture sessions.