Do you experience numbness, tingling, burning sensations or weakness in one side of your neck, a shoulder or in your hands or arms? If you do, you may be suffering from thoracic outlet syndrome (TOS).
My name is Dan Dakin and I am a Registered Massage Therapist at Momentum Health in Kelowna, British Columbia. Today I’d like to invite you to pour yourself a mug of something tasty and take a ten-minute health break and think with me about something that is affecting multitudes today.
A friend of mine started experiencing numbness, tingling and weakness in her right hand a few months after the birth of her first child. As the child grew, her symptoms intensified and she started dropping things. At first, she thought she was just going through a clumsy phase, but the phase wouldn’t end. She got to where she stopped picking things up with her right hand because she couldn’t be sure she wouldn’t drop things, like a cup of tea or, worse, her baby. But every bodily compensation comes with a price and, after a few weeks, she began experiencing similar symptoms in her left hand. Now she was scared, wondering how she was going to care for her baby with two weak, tingling hands. She wanted answers, so she started looking things up on the internet but this only led to confusion and more fear.
Finally, she told me about it and I was surprised to learn she had not even mentioned it to her doctor in her post-natal check-ups. But I shouldn’t be surprised and neither should you. People are amazing at adapting their bodies to new circumstances. We are wonderful compensators; we find a way to do what we need to do. Our society values toughness and independence; nobody wants to be a whiner or a weakling, always asking for help. So what do we do? We “play through the pain” and suffer silently.
When she finally told me what was going on, I offered to treat her and within five weekly treatments and daily adherence to a few simple but carefully prescribed exercises, she was symptom-free. She suffered for almost a year before seeking help and this suffering was so unnecessary. Of course, not everyone responds to treatment the same way. With some people relief may take more or less time than her situation and in some cases, surgery may be required.
What was she suffering with? She had assumed it was the better-known carpal tunnel syndrome (CTS), but a few simple orthopaedic tests told me her problem was actually thoracic outlet syndrome (TOS). The symptom-picture for CTS is quite specific: numbness and tingling in one or more of the first three fingers (thumb, index and middle finger), sometimes accompanied by pain or burning running up the “palm side” of your forearm. The hand may feel weak, the wrist may be sore. Symptoms may “come and go” and may vary from day to day.
What causes CTS symptoms? The median nerve is impinged as it travels through the carpal tunnel at the wrist/hand junction. The carpal tunnel is narrow to begin with, being surrounded by carpal (wrist) bones and covered by a thick band of connective tissue which is actually a ligament (the transverse carpal ligament). There’s just enough room for the median nerve, some blood vessels and nine tendons that flex the fingers and thumb. With so many structures going through this passage, all it takes is a little inflammation pressing on the blood vessels, depriving the median nerve of oxygen, causing strange sensations and dysfunction of the nerve. Surgery can relieve the pressure but, like all surgical procedures, it is not without risk and is usually unnecessary. Natural, less invasive manual therapies, such as massage, can manipulate the transverse carpal ligament and the tendons that pass through it, reduce the tone of the muscles that pull on those tendons, mobilize the carpal joints, increase blood perfusion to these tissues and so relieve your suffering.
The symptom picture of Thoracic Outlet Syndrome (TOS) is much more generalized. Like CTS, TOS is an impingement of the nerve and/or the blood vessels that supply those nerves. Only instead of one nerve being impinged, it could be any of the brachial nerves and their respective branches and accompanying blood vessels and, rather than only one site of impingement, there are several possible impingement sites. The impingement could be at the nerve roots as they pass between the scalene muscles on the side of your neck, on the nerves and subclavian artery passing under the clavicle (collar bone), under the deeper muscles of the upper chest or in the armpit… wherever the muscles of the arm or hand may be hypertonic (very tight, hard), where joints may be inflamed or the ligaments of the joints may be shortened and restrict joint mobility. Sufferers could experience lack of sensation, numbing or “zingy” feelings, tingling, burning or weakness (because muscles receive their “marching orders” from motor nerves) in their neck, shoulder or anywhere in their arm or hand.
In my friend’s case, she felt it in all her fingers, but at different times. One day she would have little or no sensation in her ring and pinky fingers of one hand and weakness across her whole palm on the other hand. Over time, she noticed the muscles at the base of her thumb were getting smaller on the right hand than on the left hand, in spite of her being right-handed. She sometimes had a persistent, irritating feeling on the side of her neck, like an insect crawling on her skin but there was no insect. It is different for everyone.
Today, more than ever in our history, people are suffering from Thoracic Outlet Syndrome or Carpal Tunnel Syndrome – or both, a “double crush” syndrome – because we live and use our bodies very differently from our ancestors. We drive, text, type, use a “mouse” and breath shallow because we sit for longer periods and so our hearts don’t have to pump as hard. Thus, our shoulders round forward, our spine slumps, our chest gets tighter, narrower and more restricted than those of our ancestors. Our neck, shoulders and jaw are held in sustained tension as we sit still, especially as we concentrate or stress about things. Our thumbs and fingers are being asked to do tiny, subtle movements more than ever before. As a result, we place less demand on the large muscles (think pecs, biceps, triceps) used to perform big movements and, since they aren’t needed, they slowly atrophy, wasting away. At the same time, we are placing huge demands on the tiny muscles in our forearms and hands and those tiny muscles have to grow to meet the demands placed on them and this can impinge the structures passing underneath or through them. As a result, we are seeing more and more patients complaining of symptoms of CTS and especially TOS.
As I pause from writing to take a sip of coffee, I am struck by how much we take our fingers, hands and arms for granted. The simplest things… pouring a hot cup of coffee, picking up the cup, turning a doorknob, slicing a tomato, buttoning a shirt, holding a fork… we rely on our hands for all of these tasks.
Do not be like my friend, ignoring the symptoms, hoping they will go away. Do not play through the pain and suffer silently. It is so unnecessary and can lead to more serious problems and injuries associated with nervous and circulatory dysfunction, especially as we get older. Get help! Here at Momentum Health, we have a team of knowledgeable, caring health care professionals that can help you to get better. Besides myself, there are three other Registered Massage Therapists, a chiropractor and an acupuncturist. Remember, every case is unique. Your situation may require only one mode of treatment or it may need two or more, working in conjunction as your personal healthcare team.
Regardless of who you see, you can expect your first treatment to begin with a thorough assessment to help your therapist determine what is causing your symptoms and then after the treatment, to help determine how effective it was and whether we need to try a different approach. Realistically, most cases will take several sessions and faithful adherence to your uniquely prescribed exercise regimen to resolve. Your condition didn’t happen overnight and is unlikely to be resolved in one treatment. That said, patients often report experiencing some relief even after the first treatment.
We want you to get better and enjoy a higher quality of life! We offer direct billing for most extended health plans. Call us at 778-484-6070 or book online at momentumkelowna.com and let us help you!
Dan Dakin, RMT