Have you ever experienced numbness and tingling in the arm, maybe even down into the hand, and your doctor has ruled out carpal tunnel? The issue may not be in your hand or wrist; it could be Thoracic Outlet Syndrome (TOS).
The thoracic outlet is a narrow space between your collarbone and the top of your first rib. Muscles, nerves, and blood vessels run through this opening or “tunnel.” When the tunnel becomes blocked, it can cause dysfunction in the nerves and other structures that run through it.
There are 3 types of thoracic outlet syndrome: Neurogenic, venous, and arterial. The latter two are sometimes grouped together and referred to as vascular TOS. Although vascular TOS is rare, it can be very serious. Vascular thoracic outlet syndrome can be caused by a blood clot or an aneurysm in the veins or arteries under the collarbone. Because of the severity of these types of TOS, it’s wise to get a diagnosis from a physician or physical therapist to rule out vascular TOS before seeking massage as treatment. In the case of vascular TOS, massage could cause more harm.
If you experience any of the following symptoms, consult your primary care doctor immediately
Bluish coloring of hand
Paleness in one or more fingers
Swelling in the arm or hand
Cold feeling in the hand or arm
Throbbing lump under the collarbone
Blood clots in the upper body
The third type, Neurogenic TOS, can be treated with massage and makes up the majority of cases. We will be discussing this type for the remainder of today’s article.
Neurogenic TOS affects the bundle of nerves called the brachial plexus. The nerves of the brachial plexus come from your spinal cord at the cervical spine and follow a path from the neck down to the arm. When muscles in the neck and/or shoulder become too tight, they impinge or press down on the brachial plexus. This can cause pain in the neck, shoulder, or arm. The impingement can also cause tingling, numbness, and weakness, which is why it’s often misdiagnosed as carpal tunnel. Symptoms can be consistent or come and go, and are usually worse when arms are raised above the head or upon waking in the morning after sleeping on the shoulder of the affected arm.
What causes TOS?
Thoracic outlet syndrome can have a variety of causes, including a traumatic injury like whiplash or overdeveloped muscles from bodybuilding. Repetitive posture or movement from a job or hobby can contribute to development of TOS. Movements or postures that cause a person’s head to come forward excessively, causes their shoulder(s) to roll forward, or requires them to have their arms over their head a lot. TOS can also have no known cause or origin.
Hairdressers, auto mechanics, carpenters, and plumbers are some of the professions more likely to develop TOS than others due to the body mechanics required to perform their jobs. Individuals who work on computers for long periods, housekeepers, and people who enjoy hobbies like swimming or painting can also develop TOS. Even carrying a heavy shoulder bag, purse or brief case over long periods can result in someone developing TOS. A structural anomaly like an extra rib can also be a contributing factor.
So, can massage help?
Yes, maybe, probably.
It all depends on if the TOS is caused by a structural or functional anomaly.
If the TOS is caused by a structural anomaly such as a subluxation in the cervical spine or an extra rib, it’s best to consult a physical therapist, or osteopath to free up a cervical spine impingement first. Addressing both structural and functional causes of TOS can provide longer term relief.
If the TOS is caused by a functional anomaly such as tight neck muscles, overuse, or positional and postural issues, techniques that target the involved tissues and trigger points can help relieve muscle tension, and reduce or eliminate muscle-related nerve impingement. Gentle stretching and passive range of motion with a mild pin and stretch of soft tissue can help restore full movement to the area.
How do you keep TOS from coming back?
Short of a career change or new hobby, those with TOS may experience recurring symptoms if they do not take care of causes such as tight muscles, repetitive movement, or less-than-optimal postures between sessions.
Self-myofascial trigger point release, followed by gentle stretching, are great between-session exercises to help manage TOS. I'm happy to show you how to do these.
Using a tool like a Theracane or a tennis ball against the wall or lying on the floor can help release tension by targeting specific tender spots in the muscle tissue. I can help identify which muscles to focus on and make sure you’re doing the exercise correctly. You don’t want to risk further nerve damage or damage to veins and arteries.
Remember, just because it might feel good doesn’t mean you need to dig in deeper; you may actually do more damage that way.
Consulting a physical therapist for strengthening exercises to improve your posture will also help.
Thoracic Outlet Syndrome doesn’t have to stop you from doing the things you enjoy. If you would like to see if massage can help relieve your TOS-related pain, you can book an appointment by visiting the online booking page or call the office at 608.620.8095