Have you ever experienced numbness and tingling in the arm or even into the hand, and your doctor has ruled out carpal tunnel? Believe it or not, the issue might not actually be in your hand or wrist; it could be Thoracic Outlet Syndrome (TOS).
The thoracic outlet is a narrow space between your collarbone and the top of your first rib. Muscles, nerves, and blood vessels run through that opening or “tunnel.”
When the tunnel becomes blocked, it can cause dysfunction in the nerves and other structures that run through it.
There are 3 types of thoracic outlet syndrome: neurogenic, venous, and arterial. The latter two are sometimes grouped together and referred to as vascular TOS. Although vascular TOS is rare, it can be very serious. It can be caused by a blood clot or aneurysm in the veins or arteries beneath the collarbone. It’s generally safest to get a diagnosis from a physician or physical therapist to rule out vascular TOS before seeking massage as treatment, as massage could cause more harm.
If you experience any of the following symptoms, consult your primary care doctor immediately:
Okay, disclaimers over. You still with me? :P
The third type (neurogenic TOS) can be treated with massage, is the most common, and will be what we are actually discussing.
Neurogenic TOS affects the bundle of nerves called the brachial plexus (see images). These are nerves that come from your spinal cord at the cervical (neck) spine and lead from the neck down to the arm. When muscles in the neck and shoulder become too tight and impinge (clamp down) on the brachial plexus, this can cause pain in the neck, shoulder, and/or arm. It also can often cause tingling, numbness, and even weakness. This is why it’s quite commonly misdiagnosed as carpal tunnel syndrome. Symptoms can be consistent or they can come and go. They are usually worse when arms are raised above the head, raised in an upward position for too long, or when sleeping on the shoulder of the affected arm.
What causes TOS?
The causes of TOS often vary. It can be a result of a traumatic injury like whiplash, or from overdeveloped muscles from something like bodybuilding. It can also very commonly be from repetitive movements or a certain posture from a job or hobby. This would be especially so if the activity causes a person’s head to come forward excessively, causes their shoulder to roll forward, or requires them to have their arms over their head a lot. And weirdly and frustratingly to some, TOS can also have no known cause or origin at all.
Hairdressers, auto mechanics, carpenters, plumbers, and health care workers are some of the many professions more likely to develop TOS than others, simply due to the body mechanics required to perform their job. Individuals who work on computers for long periods, housekeepers, and people who enjoy hobbies like swimming or painting can also develop TOS. Even carrying a heavy shoulder bag, purse or briefcase over a long period can result in someone developing TOS.
A structural anomaly like an extra rib can also be a contributing factor.
So, can massage help?
Yes, maybe, probably. (I know, super helpful.)
In all honestly, it really depends on if the TOS is caused by a structural or functional anomaly.
If the TOS is caused by a structural anomaly such as subluxations (that's when a joint is slightly out of alignment) in the cervical spine, or from an extra rib, it’s best to consult a physical therapist, chiropractor, or osteopath to free up a cervical spine impingement first. Addressing both structural and functional causes of TOS can provide much better and longer term relief.
If the TOS is caused by a functional anomaly such as tight neck muscles, overuse, or positional and postural issues, massage techniques that target trigger points can help relieve muscle tension (like trigger point therapy and myofascial release), and reduce or eliminate muscle-related nerve impingement. Other techniques that can be used are gentle stretching and passive range-of-motion movements, and can help restore full movement to the area. These are all techniques I can provide as a massage therapist.
How do you keep TOS from coming back?
Unfortunately, short of a career change or new hobby, those with TOS may experience recurring symptoms if causes remain unaddressed, such as tight muscles, repetitive movement, or poor posture between sessions.
Self massage with myofascial trigger point release, followed by gentle stretching, are great exercises to help manage TOS between sessions. I can teach you how to do this if you'd like.
I highly recommend using a tool like a Theracane or a tennis or lacrosse ball against the wall or lying on the floor can help release tension by targeting specific tender spots in the muscle tissue. Your massage therapist (it's me, hi!) can help identify which muscles you should focus on and show you how to do the exercise correctly. There's a lot going on in this part of the body, and you don’t want to risk further nerve damage or damage to veins and arteries.
Remember, just because it feels good doesn’t mean you need to dig in deeper; you might actually be doing more damage this way.
Consulting a physical therapist for strengthening exercises to improve your posture will also help.
Thoracic Outlet Syndrome doesn’t have to stop you from doing things you enjoy!
If you would like to see if massage can help relieve your TOS-related pain, you can book an appointment with me by clicking here.