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.
One of the most common goals for the new year is a decision to be more active. I started day one of January first with an invigorating Polar Bear swim! One of the most common blocks to being more active is pain. Pain management is where I can help.
Acupuncture can be very effective to treat pain from many causes, from injury and surgery recovery, to arthritis, to menstrual cramps, to headaches, to migraines, to digestive disorder pain, and more. Check out my website for more specific information for each of these types of pain: http://www.activetcm.com/pain_management/
There are a multitude of supplements both online and in stores with claims to cure your pain, but which ones are right for you? First of all, that depends on your type of pain. Is it from muscle injury? Joint degeneration? Nerve impingement? Internal organ disease? Immune system imbalance? Hormonal imbalance? All of the above? None of the above?
Because there are so many causes for pain and because pain is such a subjective experience, it is important to get a proper assessment. That usually starts with a complete and thorough consultation determining when/how the pain started; what aggravates the pain; what alleviates the pain; what concurrent medical issues there might be; what the health history indicates; whether lifestyle, emotional, mental, or spiritual aspects are big contributors (they always contribute something!); and more.
Some common supplements that may crossover treatment for several different kinds of pain include magnesium, fish oils, and coenzyme Q10.
Though magnesium is found in a lot of foods, including dark leafy green veggies, legumes, and nuts, rates of deficiency are high in North America. In fact, approximately 68% of the US population consumes less than the RDA (recommended dietary allowance) of magnesium and 19% of the population consumes less than 50% of the RDA!
Magnesium deficiency can contribute to muscle cramps and tightness, migraines, fatigue, poor sleep, weak bones, menstrual cramps, and anxiety.
Supplementing magnesium is easy. Look for magnesium glycinate, bisglycinate, or citrate, avoiding magnesium oxide, which draws water into the bowels to act as a laxative (thus poorly absorbed). I most often recommend magnesium glycinate capsules or magnesium citrate powder.
It almost impossible not to have heard about omega 3 essential fatty acids. These “good fats” are often in the news because of their many health benefits, including reducing inflammation, improving heart health, decreasing joint pain, supporting healthy skin, and easing depression.
My mom also told me years ago to eat more fish so I could be smart. I admit I hated fish. Though I’ve now learned to like it, I still take fish oil capsules as I know that I cannot eat enough fish to match my busy and active lifestyle and supply me enough DHA and EPA (main components of the omega 3s from fish).
When choosing a fish oil, quality is key. Poor quality fish oil capsules may taste fishy because the oils are rancid. Inappropriately processed fish oils may not be as health beneficial because heat and light can destroy these delicate fats.
If you want to know more about which fish oils I prefer, feel free to ask me.
This powerful antioxidant can be your buddy and you can call him by his nickname CoQ10. He will help protect you; he can be your body guard. As an antioxidant, he assists in decreasing cellular damage. CoQ10 is also involved in making a key energy molecule called ATP. Thus, if your body doesn’t get or make enough CoQ10, you may feel fatigued and/or depressed and many of your body’s processes will not function properly.
Your body makes CoQ10 and we also consume it via oily fish, organ meats, and whole grains.
So, how do you know if you have enough? If you have high cholesterol, high blood pressure, or heart disease, you may benefit from taking CoQ10. Statin drugs so commonly used to treat high cholesterol contribute to lower CoQ10 levels, so if you are taking these drugs, talk to your health provider to determine if supplementing will benefit you.
CoQ10 has also shown great promise for treating migraines at dosages of 150mg-300mg daily. Once again, quality matters.
As always, feel free to ask me. Contact me here.
Some of the tons of research and articles on acupuncture to treat pain:
Traditional Chinese acupuncture is “effective” at reducing knee osteoarthritis pain and improving function in people with knee osteoarthritis, say the researchers, who presented their findings in San Antonio at the American College of Rheumatology’s annual scientific meeting.
Arthritis Responds to Weather, Acupuncture United Press International – Oct. 19Washington Post – Oct. 19
Researchers told attendees at the American College of Rheumatology’s annual meeting that they have compiled valid data indicating changes in temperature or atmospheric pressure can cause increases in joint pain. Marc Hochberg, MD, MPH, a professor in the School of Medicine, says the studies ” . . . allow us to conclude that traditional Chinese acupuncture is an effective intervention for the relief of pain and improvement of function in patients with osteoarthritis of the knee.”
Acupuncture can ease the discomfort while waiting for an operation and perhaps even serve as an alternative to surgery. Seven patients have responded so well that at present they do not want an operation. (USD 9000 saved per operation).
Acupuncture to treat Rheumatoid Arthritis
ZHEREBKIN, Eastern Europe, conducted a randomised controlled clinical trial to study the efficacy of the multi-modality treatment of rheumatoid arthritis (RA) involving acupuncture (A) treatment.Methods: Measures assessed included the number of the inflamed joints, the joint index, duration of morning rigidity and a visual scale of pain.Results: Combining treatment of RA with Acupuncture was found to more effectively lower the values for the joint index and the visual scale of pain.Conclusions: The results of this trial indicated that acupuncture may improve the results of drug treatment.Zherebkin VV.
The use of acupuncture reflexotherapy in treating patients with rheumatoid arthritis. Lik Sprava 6: 175-7. Nov-Dec 1997. Acupuncture for Chronic Low Back Pain: A Randomized Placebo-Controlled Study With Long-Term Follow-Up. Articles Clinical Journal of Pain. 17(4):296-305, December 2001.Carlsson, Christer P. O. M.D., Ph.D.; Sjolund, Bengt H. M.D., Ph.D. Abstract: Objective: The authors sought to determine whether a series of needle acupuncture treatments produced long-term relief of chronic low back pain. Design: A blinded placebo-controlled study with an independent observer. The patients were randomized to receive manual acupuncture, electroacupuncture, or active placebo (mock transcutaneous electrical nerve stimulation). Subjects were examined and monitored by an investigator who was blinded to the treatment given. Setting: A tertiary-level pain clinic at a Swedish university hospital. Patients: Fifty consecutive patients (33 women, 17 men; mean age, 49.8 years) with chronic low back pain (mean pain duration, 9.5 years) and without rhizopathy or history of acupuncture treatment were included in the study. Interventions: Treatments were given once per week for 8 weeks. Two further treatments were given during the follow-up assessment period of 6 months or longer. Outcome Measures: The independent observer made a global assessment of the patients 1, 3, and 6 months after treatment. The patients kept pain diaries to score pain intensity twice daily, analgesic intake, and quality of sleep daily, and activity level weekly. Results: At the 1-month independent assessment, 16 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo group showed improvement (p <0.05).The authors found a long-term pain-relieving effect of needle acupuncture compared with true placebo in some patients with chronic nociceptive low back pain. (C) 2001 Lippincott Williams & Wilkins, Inc.
Back-pain acupuncture ‘effective’
Acupuncture proved an effective form of therapy for treatment of accident patients with whiplash injuries, representing a valuable supplement to the field of rehabilitation.
Both physiotherapy and acupuncture treatment groups improved in reduced pain, improved range of motion, and better overall health following treatment for chronic neck pain. Acupuncture was slightly more effective in patients who had higher baseline pain scores.
The high percentage of positive results in whiplash injury patients leads us to advocate acupuncture for balance disorders due to cervical pathology.
HEADACHES & MIGRAINES
Acupuncture as Effective as Drug Therapy for Migraines & Headaches
Acupuncture Cuts Tension Headache Rates By Almost Half
ABUAISHA and colleagues, Department of Medicine, Manchester Royal Infirmary, University of Manchester, UK studied the use of acupuncture to determine its efficacy for pain relief for peripheral diabetic neuropathy.Methods: 46 diabetic patients suffering chronic painful peripheral neuropathy participated in the study. 29 (63%) patients were already receiving standard medical treatment. Patients initially received up to 6 courses of classical acupuncture analgesia over a period of 10 weeks, using traditional Chinese Medicine acupuncture points.Results: 46 patients completed the study. 34 (77%) showed significant improvement in primary and/or secondary symptoms (P <0.01).
SOFT TISSUE INJURY
Acupuncture treatment on soft tissue disease based on TCM syndrome differentiation theory is thus shown to be effective.