|
Chiropractic Neurology & Balance
Vertigo & Dizziness
Chiropractic Neurology &
the Metabolic System
Thyroid Issues
Autoimmune Disorders
Gastrointestinal Disorders
Osteoporosis/ Osteopenia
Insomnia/Sleep Problems
Chiropractic Neurology & Learning
Attention Disorders
(ADHD & ADD)
Autism/Asperger's
Syndrome
Obsessive Comulsive Disorder
Dyslexia
Chiropractic Neurology & Movement
Distonias, Tics and Tremors
Chiropractic Neurology & Pain
Fibromyalgia
Headache/Migraines
Peripheral Neuropathy
|
What is Thoraic Outlet Syndrome (TOS)
TOS is categorized by several distinct types of disorders which affect the brachial plexus nerves (those that pass into the arm from the neck) and the nerves and arteries that that pass between the neck to the armpit. The thoracic outlet is surrounded by bones and muscle tissue, and any activity, injury, or disease that causes engorgement or swelling in this area can cause symptoms. Repetitive stress, rounded posture, heavy exercise, whiplash accidents, ergonomic (work) conditions such as long hours at a computer, tumors, as well as a cervical rib (an extra rib from birth) can cause compression of the brachial plexus. Symptoms can include neck, shoulder, and arm pain with numbness, tingling, fatigue, and impaired circulation (discoloration) of the extremities. Symptoms can range from intermittent to constant and from mild to severe. There is much confusion surrounding TOS and few clinicians are properly trained to recognize and treat it. Here are the different types:
(1) True Neurological TOS (numbness, weakness, and wasting of hand muscles usually on one side of the body) is mostly confined to middle aged women. This is rare and caused by birth abnormalities.
(2) Arterial TOS (sensitivity to cold in hands and fingers, numbness and pain in the fingers, finger ulcers, and loss of blood circulation to the affected arm). This is also a rare disorder.
(3) Venous TOS affects men and women equally and is again a rare occurrence. The cause is unknown but usually follows prolonged use of a limb (usually the arm and shoulder)
(4) Disputed TOS, also called non-specific TOS, is very common. Symptoms include pain, weakness, and fatigue and it is caused by subtle injury to the nerves and vessels in the brachial plexus. Many medical physicians believe it doesn't exist. There are numerous objective tests including MRI that can be performed but rarely do they reveal as much as the clinical findings. It takes a skilled clinician to identify and treat disputed TOS
(5) Traumatic TOS is somewhat self-explanatory and is similar to dispute TOS except that the cause is usually more dramatic by falls, auto accidents, work injuries, and repetitive stress which can cause a stretch on the nerves and vessels of the Thoracic Outlet. The symptoms can include pain and tenderness, numbness, tingling, or burning in the hands, legs and feet, loss of sensation and weakness. This is also a common TOS condition
How Is TOS Diagnosed?
The vast majority of TOS will fall into two of the above categories (1) Disputed TOS and (2) Traumatic TOS. The importance of the history and neurological examination cannot be overstated. Provocative maneuvers to the neck, shoulder, and hand as well as the identification of trigger points can verify the diagnosis. Objective testing such as angiograms, somatosensory evoked potential tests, electromyograms, vascular ultrasound, pneumatic plethysmography, and brachial plexus MRI are also available but will be unremarkable unless the condition is well advanced.
As a chiropractic neurologist, Scott Brown DC, DABCN has a thorough understanding of the neuromuscular and neurovascular connections as they relate to TOS. He is trained to detect and correct the problem before irreversible damage occurs.
What Is The Treatment For TOS?
First the clinician must identify the cause. The treatment for a tumor is obviously different from the treatment for traumatic injury. If the condition does not call for emergency surgery (rare), then the following procedures may be implemented:
(1) Manipulation to restore normal biomechanics to enhance reflexive relays to brain feedback loops which aid in correcting rounded shoulders and restore postural integrity.
(2) Orthopedic supports to help relieve the pressure on the brachial nerves and arteries.
(3) Cold Laser therapy for improved circulation, metabolism, and wound healing as well as anti-inflammatory, anti-swelling and analgesic effects.
(4) An exercise and physical therapy program to strengthen weakened postural muscles.
TOS Sufferers should never sleep on their stomach. Patients should avoid prolonged overhead positioning. Obese patients should try to lose weight. Those with ergonomic causes of TOS should take regular work breaks and have an ergonomic evaluation at their workplace.
What Is The Prognosis For TOS?
With early detection, in the majority of cases, the prognosis is good. The recovery process can be long term and be easily set back by a few days of postural or physical improprieties (lifting, overhead work, stomach sleeping, etc.) In cases that are either severe or longstanding, a surgical resection may be required to open the thoracic outlet. This may include removal of a cervical rib to prevent further compression of the brachial plexus or subclavian artery.
|
