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What You Need to Know About TOS (It’s Not Terms of Service)

By Dr. Molly Casey

Thoracic Outlet Syndrome

If you have tingling, numbness, and pain in the fingers and hand, where is the problem in -- your hand and fingers? Most people would say yes, it is likely in the hand and fingers. What if I told you that may not be the truth?

Some, thinking a little outside of the box, may point to the wrist, or blame carpal tunnel syndrome or -- if they are really outside of the box thinkers -- might even suggest the elbow. Although it’s counterintuitive, just because you have pain in one area doesn’t mean that is the location of the problem. The brain communicates with the rest of the body by sending messages down through the spinal cord and out miles and miles of nerves to its intended structure, organ, or cell. So, there are many places the problem can exist. For example, sometimes pain, numbness, and tingling in the hands and fingers can indicate a problem called thoracic outlet syndrome (TOS).

Thoracic Outlet Syndrome

There are more than 300 separate joints in the full spine. The thoracic spine is the portion of the spine that connects your neck (cervical spine) and your low back (lumbar spine), so the thoracic spine is your mid back. The thoracic spine alone has over 220 separate joints, so this is a large piece of the puzzle that people often overlook, or don’t speak of, in terms of back pain and problems.

In any event, there are many areas that can cause irritation and problems. One is the thoracic outlet. In this outlet, there is a group, or plexus, of nerves and blood vessels that help communication between the spine and upper extremities (arms).

This plexus of nerves and blood vessels is located in the front of the neck, shoulder, and chest. It can easily be compressed by ribs, collar bones, and/ or associated muscles. When this compression occurs, the condition is called thoracic outlet syndrome (TOS) and symptoms result. Don’t let the name confuse you; although it does have to do with upper thoracic vertebrae and ribs, the cervical spine is often involved as well.

Symptoms and Causes

TOS occurs when the plexus of nerves are compressed. The symptoms are tingling and numbness of hands and fingers, especially the fourth (ring) and fifth (pinky) digits, difficulty grasping objects, weakness with specific positions of the arm, swelling of the hands/arms, sensations of cold in the upper extremity, and potential color changes.

There can be a number of underlying causes with TOS. Sometimes a previously fractured or subluxated collar bone, cervical ribs (extra ribs that extend off lower vertebrae in the neck), sustained muscle tightness and/or repetitive motions of arms and upper thoracic spine while at work can cause or contribute to TOS. Hairdressers frequently suffer from TOS due to the position of their arms at or above shoulder height for hours on end daily. Health practitioners will frequently confuse TOS with disc herniations, shoulder bursitis, or even disorders of the elbow.

Conservative Care

What should you do if you find yourself with pain, numbness, and/or tingling in your hands and fingers? Get assessed by a professional. If it ends up that you are dealing with TOS, chiropractic care can help. Doctors of chiropractic will examine the function and mobility of the cervical vertebrae, collar bone, upper ribs, and upper thoracic spine. If there is misalignment or lack of proper motion (subluxation), the chiropractic adjustment will restore proper alignment and joint motion. This can alleviate the cause of the problem and create more space for the structures to communicate optimally and decrease symptoms.

In addition, supportive care in the form of stretches and muscle work can be recommended in order to increase flexibility, motion, and stability of that area. Natural supplements that decrease inflammation can be directed in order to support the natural healing process. Proper ergonomic and postural instruction can be given in order to assure better spinal alignment at work and in daily life in efforts to increase function and reduce symptoms.

Sometimes the problem isn’t found where the symptom appears. Don’t be fooled. If you find yourself suffering with TOS symptoms, head into The Joint Chiropractic and let the doctors of chiropractic help you jumpstart your journey to healing in the most conservative way possible.

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