|
TOS or Thoracic Outlet Syndrome (Cervicobrachial Syndrome, Myogenic TOS,
myofascial TOS, Scalenius Anticus) |
|
The thoracic outlet is an area in the shoulder where the nerves and
vessels travel. Since these nerves go into the hand, when irritated, they can cause
numbness and tingling as well as swelling and weakness. Notice that the
scalene muscles go from the neck to the ribs. These muscles
are commonly tight after a whiplash injury due to the
loss of curvature
in the neck. Tight scalenes tend to close in the walls of the thoracic outlet
and compress the nerves. When these muscles are tight, the first rib (and 2nd/3rd)
are pulled up, further closing down this space and making it even tighter for the
nerves. Finally, a forward shoulder can also cause this area to get tight.
Treatment is
restoring the normal curve in the
neck, promoting good posture through
thoracic extension,
manual stretching of the scalenes, and
mobilization
or manipulation of the first, second, and third ribs. Treatment may also include
aggressive manual stretching of the chest wall and nerves. Testing is almost always
false negative. Most doctors will try to get an EMG/NCS, but this is usually normal
and misses the diagnosis. Finally, while surgery is an option in the most severe
cases (less than 1%), it's not considered in the vast majority of patients with this
problem.
|
|
|
|
