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  • Dr. Donald Littlewood

Did you know that the weird symptoms in your arm could be coming from the structures in your neck?



And it’s more common than you think!

Thoracic outlet syndrome (TOS) is a group of disorders that happen when there is compression, injury, or irritation of the nerves or blood vessels in the lower neck & upper chest area.


The most common of these conditions is called neurogenic TOS (nTOS). As a chiropractor, it is also the kind that I can treat, so let’s focus there.


nTOS is common in those who participate in sports that require a lot of overhead movements. Think volleyball and baseball.


However nTOS doesn’t only happen in athletes. It’s also common in those who sleep with their arm above their head, and those with poor muscular development & posture.


And with people walking around on their cellphones all day, who doesn’t have bad posture?!


So now we know what nTOS is, let’s talk about the symptoms.


Symptoms of Neurogenic TOS


The symptoms can vary slightly with nTOS, but there are some features that remain present pretty much across the board.


nTOS often starts with neck pain that is worse with specific neck movements. Along with this pain & painful movements, symptoms like numbness, tingling, or pins and needles are usually felt down the arm.


There is often also muscle weakness of either the forearm or hand, and grip strength is usually diminished as well.


Why do all of these symptoms happen?


Compression of the brachial plexus.


Time for an anatomy lesson!


Anatomy of nTOS



Right next to the lower neck there is a little space called the thoracic outlet (hence thoracic outlet syndrome!). Through this thoracic outlet runs the brachial plexus.


The brachial plexus is a network of nerves that come from the neck (C5-T1 to be exact), merge together, form new nerves and then continue along down the arm to supply all the muscles and skin allowing us to move and feel different sensations.


Abnormalities of the bones & soft tissue in the lower neck can compress the brachial plexus and irritate the nerves.


Now obviously a chiropractor cannot change a bony abnormality; I can’t remove a rib or shorten the transverse process of C7. But I CAN help with the soft tissues.


The scalenes, pectoralis and subscapularis muscles are all generally involved here, as well as the more common trapezius and levator scapula.


On top of the tight muscles, chances are your neck, upper back and first rib aren’t moving the way they should be.


Chiropractic Care & nTOS


Chiropractic care has been shown time and time again to be safe and beneficial in treating nTOS.


Soft tissue therapy of the muscles above can really relax the tightened muscles, and reduce the swelling that is in the area. This will allow the brachial plexus to move more freely and decrease the compression.


In nTOS, the vertebrae of the neck & upper back are likely not moving very well, so we adjust them. Adjustments are geared at creating joint movement where movement is lacking. This is the traditional “crack” that most people think of when going to a chiropractor.


(NB on adjustments: this will not be done without consent from you. If you do not want to be or cannot be, adjusted there are other things that can be done. This is a conversation that always happens in my office).


Exercises & nTOS



The muscles that is most commonly aggravated in nTOS are the anterior and middle scalene muscle. This is a really effective stretch to get both of those muscles and relieve the some of the immediate tension you are feeling.


(Just a little caveat: the scalenes aren’t usually stretched so a lot of people find this one painful. Take it easy and don’t push your limits!)


Start seated in a comfortable position you are going to loosely hold onto the bottom of the chair on the same side that you are feeling symptoms. Then, using your hand, you are going to pull your head to the opposite side and up towards the sky.


Final Thoughts


Neurogenic TOS is more common than people think and responds incredibly well to chiropractic care and exercise.


If this sounds like you or someone you know, it is never too late to start care. Send me an email and I would be more than happy to chat!


In health,

Dr. Donald Littlewood

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