The thoracic outlet is a space between the clavicle -- or collarbone -- and the first rib, one on each side of the neck. A vein, an artery and a bundle of nerves travel from the neck through the thoracic outlet toward the arm. Thoracic outlet syndrome is a collection of symptoms that develop when this opening is narrowed, compressing the vessels and nerves. The symptoms include numbness and tingling in the arms and hands, coldness in the chest or arms, weakness, pain and fatigue in the arms. The problem can be on one side only or bilateral.
If you look at a good picture of the anatomy in that area, such as this drawing here on the UCLA School of Medicine website, it's easy to see that there are three places where the compression can occur: between the anterior and medial scalene muscles, between the clavicle and first rib, and where the vessels pass between the pectoralis minor muscle and the first rib.
Compression in these areas can be due to an injury, such as a fractured clavicle, or to repetitive movement, such as repetitive exercises that require you to lift your arms over your head, or exercises that tighten the scalene and pectoralis minor muscles. It can also be congenital, due to a malformation of the clavicle and/or the first rib.
The scalene muscles and the pectoralis minor not only stabilize the neck and shoulder area, they are also secondary breathing muscles. They can become overdeveloped due to asthma or to constant exercise that forces you to breathe very deeply to catch your breath. If they are tight and overdeveloped, they squeeze the nerves, veins and artery.
If your symptoms are due to tightening of these muscles, massage can help by releasing them and balancing your shoulder and neck muscles. However, because of the presence of delicate nerves and blood vessels between the scalene muscles, only an experienced massage therapist with an excellent knowledge of anatomy should massage that area.
If your symptoms are due to an injury to the clavicle or the first rib, you'll need to see an orthopedic physician for an evaluation. If the clavicle is broken, massage is not advisable. If the clavicle has healed incorrectly so that it is pressing on the nerves and vessels in the thoracic outlet, surgery may be necessary.
There is another important consideration: sometimes compression on the veins can cause thrombosis -- a blood clot. Massage is definitely contraindicated if there is a blood clot, as dislodging the clot is very risky. So, if you develop the symptoms of thoracic outlet syndrome, see a physician to rule out damage to the bones or a blood clot. Once you are sure there is no risk of blood clot, your massage therapist can certainly help you with the muscles involved in thoracic outlet syndrome.
Thoracic Outlet Syndrome
Thoracic Outlet Syndrome
About Me
- Lisa L. Ross, HHP
- I have actively practiced as a Holistic Health Practitioner (HHP) and massage therapist since 1993 with special interest and training in the Vodder method of Manual Lymph Drainage (MLD) technique. My experience is with lymphedema disease, edema in general, pre- and post-surgery massage, cosmetic surgery edema and more. My search for a low or non impact movement modality led me to become a certified trainer in the GYROTONIC EXPANSION SYSTEM® I have found it to be a helpful movement modality to stimulate the Lymphatic system and other stagnation out of the body. The Gyrotonic method is the base for movement sessions used at the office. Palliative care is another direction of great interest, as many of my clients are in disease states. My mission is to provide compassionate care and resources for my clients.
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