Source:
CASE REPORT: Role of Acupuncture in Thoracic Outlet Syndrome
Dr. M Tariq, Dr. Jawad Zahir and Dr. Salman Ahmad Saleem
Acupuncture in Medicine Dec 2000 VOL 18(2);pp.122-3

Abstract

This report describes a case of Thoracic Outlet Syndrome (TOS) which was successfully treated with acupuncture after failed conservative management with a variety of interventions.

Webmaster's Note:
This is a brief summary of this case report, the full text of which is available in the paper and electronic versions of the Journal.

A 21 year old woman had suffered with pain in the neck, scapular region and chest, with brachialgia and with paraesthesia of the left hand, for three and a half years. She had been treated without any lasting relief with a variety of modalities, including NSAIDs, opiods, physiotherapy, short wave diathermy, ultrasound and nerve block therapy.

She was treated daily with electroacupuncture to points ST38, LI4, LI11, LI15, and TE14, for 10 days, with some improvement. She was then given three further week-long courses, at fortnightly intervals.

Initial diagnosis was made, and subsequent improvement was documented, by performing nerve conduction studies. The motor velocity across the neck improved from 58 m/sec to 70 m/sec in the ulnar nerve. The patient remained symptom free after 4 months follow-up.

It has been suggested that acupuncture can reduce tissue inflammation and promote repair of tissues. Such effects may result in decompression of neurovascular structures in TOS, and thus resolution of the condition.

Dr. M Tariq
Registrar Dept. of Anaesthesiology,
Holy Family Hospital Rawalpindi-Pakistan.
Email: muhammadtariq @ hotmail.com

See also: Frozen shoulder: Complementary and alternative medicine - MayoClinic.com

Source:
Therapy for TOS
From: Marcia Woolf
Subject: Therapy for TOS. Some Questions.
To: Multiple recipients of list SOREHAND « SOREHAND@ITSSRV1.UCSF.EDU »
Status: RO
Filled with useful exercises from multiple contributors.

1. Scalene stretch -- (I read the suggestion about sitting on your palms and my pain level went up several points. I'm afraid to try that, but might if I get my nerve up.) This method may not be any easier depending on your symptoms, but here's what my PT suggested (may be impossible when nerve pain at elbow is present): Place the right palm at the base of the neck with fingers over left clavicle (sort of like doing "The Pledge" only higher, and pressing as firmly as you can). Now lean your head back at about halfway and then lean right at about the same angle until you feel the stretch. Hold 10-20 seconds. Repeat on other side.



2. Pectoralis stretch
   
   
   1. -- Stand just inside a doorway facing the jamb without hinges. Place forearm closest to door against doorjamb, from elbow to palm. Lean/Step forward and to opposite side to stretch pecs. I do this against my bookcase and window sill also.
   
   
   
   2. -- Another stretch is to place both forearms on wall with one foot back away from wall, and other foot forward halfway to wall and then lean into the wall. (While I offer this one, I never feel like it does the trick, but maybe for you... )
   
   
   
   3. -- Sitting, arms in hold-up position, lean back in chair and press arms back -- move hands up and down to vary the stretch (I made this one up, and I hope it's safe; I think it's effective).
   
   
   
   4. -- This one is advanced, when you can handle it. Lying on side in fetal position (hip and knees at 90 degrees), do arm circles with uppermost arm... [Read more]

Source:
Physical Therapy Corner: Thoracic Outlet Syndrome
Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT)

...Conservative treatment usually includes local heat and a program which address postural retraining, shoulder strengthening and stretching exercises. The practitioner will create a treatment program specific to the presenting symptoms. Below are a few self-stretching exercises. All of these exercises should be performed slowly and carefully. Each position is assumed smoothly to the point where a stretch is felt intensely but with no pain. There should be no bouncing in any of these positions. Hold the stretch for 30 seconds and then gently and slowly release it. Wait 10 seconds and repeat the stretch 3-5 times. If the stretches increase the symptoms do not continue...

Illustrated exercises include (1) stretching the back of the neck, (2) stretching the chest, (3) stretching the side of the neck, (4) stretching the shoulder and the chest, and (5) mobilization of the first rib.

Commonly applied provocation tests are also shown. "These tests may or may not momentarily reproduce symptoms but ... are important in ruling out other causes which may produce similar symptoms." They include (a) the EAST [Elevated Arm Stress Test] or "Hands-up" Test, (b) the Adson or Scalene Maneuver, (c) the Costoclavicular Maneuver, (d) the Allen Test, (e) the Provocative Elevation Test. See infra.

Source:
Thoracic Outlet Syndrome
eMedicine Clinical Knowledge Base, Last Updated: 6 October 2006

According to Andrew K. Chang and J. Stephan Bowen, several provocation tests are unreliable.

Physical: In most cases, the physical examination findings are completely normal. Other times, the examination is difficult because the patient may guard the extremity and exhibit giveaway-type weakness. The sensory examination is often unreliable.

• Provocative tests, such as the Adson, costoclavicular, and hyperabduction maneuvers, are unreliable. Approximately 92% of asymptomatic patients have variation in the strength of the radial pulse during positional changes.
  
  
• The elevated arm stress test (EAST) is of debatable use, but it may be the most reliable screening test. It evaluates all 3 types of thoracic outlet syndrome (TOS).
  
  
  • To perform this test, the patient sits with the arms abducted 90 degrees from the thorax and the elbows flexed 90 degrees. The patient then opens and closes the hands for 3 minutes.
    
    
  • Patients with TOS cannot continue this for 3 minutes because of reproduction of symptoms. Patients with carpal tunnel syndrome experience dysesthesias in the fingers, but do not have shoulder or arm pain...

The authors present a comprehensive table of medications, including anticoagulants, Tricyclic antidepressants (TCAs) and analgesics, with further recommendations for inpatient and outpatient care.

Further Outpatient Care:

• For most patients, conservative treatment is recommended. Stress avoidance, work simplification, and job site modification are recommended to avoid sustained contraction and repetitive or overhead work that exacerbate symptoms.
  
  
• Address myofascial or chronic pain elements through exercise programs, good posture, and self-management.
  
  
• Maximize the potential outlet space through a program of stretching and strengthening of the shoulder-elevating mechanism.
  
  
  • Trapezius and rhomboid strengthening (eg, shoulder shrugs and bilateral shoulder retraction while standing or lying prone)
    
    
  • Shoulder mobilization (eg, hand circles and standing corner pushups)
    
    
  • Postural exercises (eg, cervical and lumbar spine extension)

In/Out Patient Meds:

• Coumadin: Anticoagulate for a minimum of 3 months for vascular TOS.
  
  
• Analgesics are seldom helpful except to assist in the institution of a progressive exercise program.
  
  
• Tricyclic antidepressants: A short-monitored course may be helpful if the time course and symptoms suggest a protracted pain syndrome.

See Also:
 Home Program for Thoracic Outlet Syndrome
 Massage 1

Source:
Self-Treatment for Carpal Tunnel Syndrome, Thoracic Outlet Syndrome, Peripheral Neuropathy: Relief for Pain, Numbness, Tingling, Burning in the Hands
Clair Davies, Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief

When confronted with pain, numbness, tingling, stiffness, burning or swelling in the hands and fingers, the universal tendency nowadays is to immediately apply the label "carpal tunnel syndrome," with very little consideration given to other possible causes.

Few people know that myofascial trigger points (tiny contraction knots) in the scalene muscles of the front of the neck are almost always involved in causing pain and other abnormal sensations in the hands. This revelation comes from decades of research by Doctors Janet Travell and David Simons, authors of the widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual. According to Travell and Simons, the scalenes are often the primary source of all the symptoms wrongly blamed on the carpal tunnel...

Although numbness and tingling in the hands are clearly the effects of nerve compression, the problem doesn't often originate in the carpal tunnel. Doctors Travell and Simons explain that the critical nerve impingement actually occurs at the thoracic outlet. This is the opening under your collarbone through which the nerves and blood vessels pass on their way to the arm.

Nerve compressions occur at the thoracic outlet when trigger points in the scalene muscles keep the first rib pulled up against the collarbone. This squeezes the brachial plexus, the thick bundle of nerves that supply the arm and hand, which passes through this area. Pressure on these nerves due to scalene trigger points is often the only cause of numbness, tingling and weakness in the hands and fingers...

In The Trigger Point Therapy Workbook, nationally certified massage therapist Clair Davies simplifies Travell and Simons' extensive research into myofascial pain and makes it accessible to the layman. His innovative methods of self-applied trigger point massage will relieve carpal tunnel syndrome, aching pain, numbness, tingling, and burning in your hands when trigger points are the cause... [Visit website]

See Also:
 Pain Reference Chart
 Myofascial Pain Syndromes, Trigger Points, & Myofascial Therapy

Source:
Osteopathic Principles Key to Treating Patients with Thoracic Outlet Syndromes
Elaine Wallace, DO, Chair of the Osteopathic Principles and Practices Department and Liaison for International Osteopathic Medicine at Nova Southeastern University, Ft. Lauderdale, Florida.
American College of Osteopathic Family Physicians (ACOFP)

Treatment of Thoracic Outlet Syndromes is truly a demonstration of dynamic osteopathic philosophy and practice. Identify the cause of the compression, treat all somatic dysfunctions, optimize normal function, and allow the body to heal itself. This approach will ameliorate most of the syndromes seen by the busy practitioner.

Attention to relaxation of Sibson’s fascia with indirect or direct myofascial release, in and of itself, will greatly affect the spatial proximity of structures in the thoracic outlet. Relaxation of all tight muscles must be attended to. Spray and stretch techniques, with or without the use of ethyl chloride, are particularly useful, as are trigger point injections of muscle spasms.

Stretching [of] the trapezius, rhomboids, and scalenes must be accomplished. Clavicular, cervical spine, thoracic spine, shoulder, and elbow somatic dysfunctions must be corrected. There is no specific benefit to utilization of direct versus indirect methods; both are effective.

In addition to osteopathic manipulation, muscle relaxants, NSAIDS, antidepressants and BOTOX have all been used in the pharmocologic approach to treatment. Biofeedback has also proven to be helpful.

However first and foremost, patients must have an evaluation of the ergonomics of their work site and activities of daily living. Remove the etiology of the compression... [Read more]

See Also:
Osteopathic Principles Key to Treating Patients with Thoracic Outlet Syndromes

Source:
Homeopathy - Thoracic Outlet Syndrome
(User entered condition)

Homeopathic remedies are prescribed by symptoms rather than conditions, as each case of a particular illness can manifest differently in different people. However, to make it quicker to find the symptoms related to Thoracic Outlet Syndrome, the symptoms experienced by a previous vistor to our homeopathic remedy finder have been grouped, by them, under the name of Thoracic Outlet Syndrome. There may be symptoms not related to Thoracic Outlet Syndrome, and this may not be an exhaustive list of symptoms.

For suggestions of homeopathic remedies for Thoracic Outlet Syndrome, tick the boxes below and press the Find Remedies button at the bottom of the screen. On the next screen, you should enter any other symptoms in the search box... [Read more]

Useful visitor comments are also included.

Source:
Thoracic Outlet Syndrome Self Care Tips
Sharon Butler, Certified Hellerwork Practitioner, Self Care for RSI

Water intake is very important for Thoracic Outlet Syndrome because the condition is so dependent on the fluid state of the muscles and soft tissues of the upper body. All the tissues that support and cradle the brachial plexus as it passes through the neck and upper chest and shoulders are dependent on proper hydration to adequately allow for normal sliding and gliding they are responsible for. If these tissues become dry and irritated, then you can imagine how this can negatively impact and prolong the symptoms of Thoracic Outlet Syndrome. Make sure you drink plenty of water each day! [Read more]

NOTE: Fluid intake may need to be monitored, depending on the specifics of your condition and the medication(s) you have been prescribed. Consult your health professional.

A treatment adjunct in TOS rehabilitation...

Nordic Walking is an efficient, low-stress exercise technique akin to cross-country skiing, using specially designed poles. Clinical and anecdotal reports indicate that this technique may prove beneficial in broad range of conditions, the arthrides, back pain, cardiac syndromes, chronic pain, fibromyalgia, obesity, osteoporosis, repetitive stress injury, thoracic outlet syndrome, depression, mood disorders, and more. Idiosyncratic variations in TOS symptomatology obviously determine the degree of movement one can undertake without pain. Nordic Walking poles are adjusted to the individual's height, limb length and reach, so that proper use of the "grip-n-go" technique engages the upper body in an integrated manner during the act of walking. The arms are not raised beyond a 90º bend at the elbow. Posture is improved and tension in the neck is released when the technique is employed correctly, reducing strain on joints through a lateral displacement of weight. Oxygen consumption and caloric expenditure are increased, with elevated heart rate and broader muscle involvement (Nordic Walking engages approximately 90% of the body's muscles). Physical and psychological benefits can be very significant. For a detailed overview, see Nordic Walking.

Tell Me About TOS
This site is filled with useful information, including a section entitled "My TOS", in which individual "TOSers" recount their personal experience of the condition and the treatment(s) they have explored — an excellent resource. There's a Treatment page which lists a range of physical therapies, injections, and other modalities that may prove helpful. You'll also find a patient-recommended Doctor List: state-by-state [incomplete]; Canada [B.C. (4) and Nova Scotia (1)]; Panama (1); Brazil (1); Greece (1).

BrainTalk Communities - Thoracic Outlet Syndrome
See also: [Archive] Thoracic Outlet Syndrome/Brachial Plexopathy
The best known TOS community. Posts are filled with salient information, as well as stories of personal experience, anguish and triumph. If you need support and advice, this forum is a good place to find it.