Let’s take a look at thoracic outlet syndrome (TOS).
TOS is a term used to describe the compression of the brachial plexus; a grouping of nerves in the neck and shoulder region. Compression of these structures can cause pain, tingling, numbness and weakness from the shoulder and into the arm – often described as ‘sciatica in the arm’; but can also be felt in the neck or even into the face. Compression is usually caused by tension in the muscles that the plexus passes through or alongside, but can also come from the top ribs or joints of the neck. Symptoms are often aggravated by raising the arm/s up. This is a fairly common condition amongst people who work with their arms held high, such as hairdressers or some machine operators. Common causes of TOS include trauma, stress, repetitive strain, posture or congenital abnormalities (such as extra ribs); though sometimes the root cause is simply unknown. TOS is most common in women aged 25-45.
Treatment is aimed at identifying and nullifying the root cause if possible; at relaxing, stretching and strengthening the muscles of the neck, or, failing that, then mobilising the joints of the neck, shoulder and upper ribs. Where TOS is caused by a congenital abnormality then referral to an orthopaedic surgeon may be warranted.
Diagnosing TOS is often not easy, as there are many other conditions which present similarly; such as carpal tunnel syndrome, tennis elbow or rotator cuff tear. Indeed it happens that a nerve damaged at one point becomes more susceptible to damage elsewhere along its length, this is a called a double crush injury.
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