Thoracic Outlet and Carpal Tunnel Syndromes

In this next installment of the Back Pain Series we jump up a little to the upper back and problems associated with tightness and misalignment in this area, and the similarity to the more localised Carpal Tunnel Syndrome.

Thoracic Outlet Syndrome

Most common in women between 20 and 50 years of age, Thoracic Outlet Syndrome (TOS) is an umbrella term to encompass pain in the neck, shoulder and arm.  For this article we will look at non-specific TOS which is usually triggered by trauma to the upper body or repetitive strain/overuse injury.

The pain is usually a dull, aching pain felt anywhere from the neck, through the shoulder to the arm and hand.  It originates from compression to the nerves and/or veins running between the neck and the upper ribs, through the clavicles (collar bones) and down through the armpit.  The compression may occur along any of these points and pain or tenderness may be felt locally at the compression site or radiate down into the arm and/or hand.  This may be accompanied by pins and needles or tingling in the 3rd and 4th fingers, the palm of the hand and in extreme cases a weakening of hand grip.

The pain associated with non-specific TOS usually worsens with activity and improves with rest.  Physical therapies to help release overtight or strained soft tissues can be beneficial as can a programme of gentle stretching, strengthening and using hot and cold therapy.  If poor posture is the cause then learning correct posture can improve symptoms by removing the stresses on the soft tissues.  A postural assessment and necessary correction can also help by realigning the body and therefore reducing the presure on overcompensating areas.

Symptoms of Thoracic Outlet Syndrome are similar to those more commonly associated with Carpal Tunnel Syndrome:

Carpal Tunnel Syndrome

Another repetitive strain/overuse injury, Carpal Tunnel Syndrome (CTS) also presents with pain, numbness, tingling and pins and needles in the hand, thumb and 1st and 2nd fingers.  It is usually caused by compression to the medial nerve in the front of the wrist.  This runs through a small compartment called the Carpal Tunnel and if this becomes inflamed due to overuse it reduces the space for the nerve to pass through and pinches it.  Due to the similarity in symptoms of CTS and Thoracic Outlet Syndrome it is important to check the neck and shoulders on any client presenting with these symptoms even if the pain is felt locally at the hand/wrist.

Rest is often advised for CTS with the wearing of a splint to keep the wrist stable and prevent overuse, however this may in turn lead to loss of muscle and strength in the arm and wrist which can lead to further problems.

Cold packs can be applied to help reduce inflammation of the wrist and massage of the arm, shoulder and neck can help to relax muscles that may also be involved.  Depending on the level of inflammation, gentle massage directly over the carpal tunnel area may also help to release, soften and stretch out the soft tissues that are contributing to the compression.  This can be particularly beneficial in the very early stages before the swelling becomes too bad.

 

As with any symptoms that persist or worsen there is no substitute for medical advice and you should check with your GP if you are concerned about your health.