By Dr. Sam Shay: Author, Acupuncturist, Chiropractor, FitGenes Practitioner, Functional Neurologist, Whole-Foods Health Coach.
Thoracic Outlet Syndrome
Thoracic outlet syndrome is where the nerves, artery, and/or vein are compressed along the way between the neck and the arm. Symptoms usually include the whole hand being in pain, numb, cold, weak, tingling, or even discoloured. Sometimes symptoms may appear to be in just the pinky and ring finger, mimicking an ulnar nerve problem or symptoms may only appear in the thumb and first two fingers, mimicking a median nerve problem.
The term ‘thoracic outlet’ refers to the space between the shoulders and the neck, but above the ribs. There are openings or ‘outlets’ there for the nerves, major artery, and vein to travel through to get to the arm and hand.
However there are 3 spots in the thoracic outlet where the nerves, artery, and vein can get trapped: 1) Between the neck muscles called the anterior and middle scalene, 2) between the 1st rib and collar bone, and 3) between the pec minor and the ribs. If any of these places, or any combination of these places are compressed, it will create symptoms (numbness, cold, weakness, etc) downstream into the hands and fingers.
Thoracic Outlet Traps
The spasming of the anterior and middle scalene can also trigger thoracic outlet syndrome on their own because the nerve and artery pass between them, while the anterior scalene spasm can compress the vein against the collarbone.
The first rib can trigger thoracic outlet syndrome because the 1st rib will ‘lift’ up into the collarbone and compress the nerves, artery, and vein when the anterior and/or middle scalene spasms. Spasming of these two muscles will ‘lift’ the 1st rib.
First Rib
The pec minor is usually spasmed from constantly being hunched forward, such as constantly working on computers, excessive working out of the pecs at the gym, guitarists, and other musicians who bring their shoulders forward.
Orthodox medical treatments include a whole host of painkillers, none of which actually address the root problem of physical compression. The other orthodox medical treatment is a very scary and dangerous surgery: removing the 1st rib and the anterior scalene. That is very dangerous because the major arteries and veins to the brain are there and the 1st rib sits right on top of the upper lobe of the lung. If there is a mistake in the surgery (which happens) you can nick the lung or the vital arteries and veins. Unfortunately, this surgery doesn’t address the pec minor issue that may be causing the thoracic outlet syndrome in the first place. Imagine getting an unnecessary surgery removing your first rib and neck muscle, yet the whole problem was actually in the pec minor.
The good news is there are non-surgical, non-drug treatments available for thoracic outlet syndrome. Below are the following combined treatments offered at my clinic in Wellington:
  1. Acupuncture on the opposite leg for instant pain relief.  This style of acupuncture is called “Dr. Tan’s Balance Method”. Think of this style of acupuncture as a double negative: Treat the opposite acupuncture channel on the opposite body part and it double negatives back to relieve the symptoms.
    1. This unique acupuncture approach has several advantages:
      1. No needles inserted into the painful hand or spasmed muscles in the pec minor or scalenes. It’s incredibly uncomfortable and painful to stick a needle into an already painful, spasmed, or inflamed muscle. Dr. Tan’s method bypasses this unnecessary pain.
      2. No needles are put near vital organs or in the neck. This method is extremely safe because needles are only inserted from the opposite knee down to the opposite foot.
      3. It works: Dr. Tan’s method is by far the fastest acting acupuncture method I’ve ever seen to reduce and eliminate pain and numbness in the hands.
      4. Frees up the painful hand for treatment with other manual methods. There is no risk of jostling needles in the hand with thoracic outlet syndrome because there are no needles in that entire arm. As a clinician, I’m now able to use soft tissue techniques, muscle work, and adjusting to treat the painful limb directly without interfering with the acupuncture.
      5. Makes manual work on the painful limb more comfortable and more effective for the patient. The acupuncture mutes the pain and discomfort of the thoracic outlet syndrome, making it much easier to work on the painful limb because the muscles are more relaxed.
  2. Myofascial (muscle and soft tissue) techniques
    1. Treating the pec minor, subclavius (muscle between the 1st rib and the collarbone), and the two scalenes requires several combined soft tissue techniques to relax the muscles, remove fascial wrinkles and scarring, and hydrate the ligaments.
    2. Fascia is a special tissue that connects all the other tissues together, like clear plastic wrap you wrap around food. If it’s bound up, wrinkled, or has scar tissue in it, it can prevent the ligaments and muscles from properly moving, creating inflammation and dysfunction. There are certain hands-on techniques used in the clinic to smooth the fascia to get the ligaments and muscles to work properly.
  3. Adjusting
    1. Gentle adjusting of the 1st rib and collarbone can greatly relieve the symptoms of thoracic outlet syndrome if the problem is coming from the 1st rib and collarbone.
  4. Home-based rehab and prevention
    1. Sleep position correction: if you sleep on your side, your shoulder can be rolled forward when you sleep on that side, or if you sleep with the shoulder up, it can still roll forward due to gravity.
    2. Bike handles: Find a way to have bike handles that don’t roll your shoulders so far forward or a shorter bike in the length of the bike so you don’t have to stretch so far ahead.
    3. Working station: look at changing your work station to a standing desk so you are not so hunched over.
  5. Reducing inflammation topically and systemically.
    • Topically, you can add natural anti-inflammatories to help reduce the local inflammation of the joints  and muscles. We carry several natural anti-inflammtory topical products to reduce the pain and inflammation.
    • Internally, you can reduce inflammatory foods and incorporate other lifestyle changes that reduce the body burden of inflammation that contributes to the pain and inflammation of thoracic outlet syndrome. I can do a comprehensive anti-inflammatory lifestyle assessment and personalised health and wellbeing program that covers diet, gut health, nutrition, toxicity, sleep, stress, and other aspects of your health, known as the “Ten Pillars of Health”.
  6. Advanced genetic testing for specific genes that control inflammation, circulation, and free radical damage (among other things). This advanced genetic testing will provide extremely specific, personalised, and proactive lifestyle recommendations based on your unique genetic makeup. You can’t change your genes, but you can change how genes express and know what lifestyle choices ‘dial up’ or ‘dial down’ inflammatory genes.
Contact me if you struggle with whole-hand pain and haven’t found answers, if your job or way of life depends on a fully functional hand, such as a musician, hands-on clinician, mechanic, computer work, or raising a family.