Is It My Neck or Thoracic Outlet Syndrome?

Neck pain can arise from many different sources with a similar clinical presentation, which can make it a challenge to diagnose. One of those related, and sometimes co-existing conditions, is called thoracic outlet syndrome (TOS). Let’s first discuss the anatomy of the neck and the thoracic outlet so we all have a good “picture” in mind of what we’re talking about.

TOS can arise from either blood vessel compression, nerve compression, or both, making the ease of diagnosis difficult. Adding to the challenge, the “pinch” of the structure can occur at more than one place! The nerves and blood vessels can get pinched at the exiting holes in the spine (“neuroforamen”), by tight “scalene” muscles, under the collar bone (clavicle), and/or by a tight pectoralis minor muscle near the arm pit. Hence, the symptoms usually include pain and numbness in the shoulder, arm, and hand (usually affecting the 4th & 5th fingers). It’s the job of your chiropractor to run different tests to figure out where the primary pinch or pinches are located so he or she can treat the right area.

The causes of TOS can be many, with one of the obvious being a fractured collar bone or clavicle. Another is from having an extra rib. As there is not a lot of room for an extra structure, this can be a point of compression for some (but doesn’t create TOS in everyone). An overly tight scalene muscle, scar tissue, an extra large muscle, and so on can also result in pinching of the nerves and/or blood vessels.

Purses, backpacks, carrying golf clubs, a mailbag, and the like can also cause a pinch. A seat belt injury from a car accident is yet another cause, either from the direct trauma, or later when scar tissue forms in the area.

A slouchy, slumped posture where the shoulders roll forwards can cause TOS. Large breasts and obesity also add to the list of risk factors. Women are affected 3x more than men. Certain jobs where reaching overhead or outwards such as food servers, carpenters, and electricians can also increase TOS risk.