By Laura Gordon
Clients come to us with all kinds of musculosketal issues. The more we become familiar with different symptomology the better we are equipped to help them. Of course we do not diagnose, however, in listening to what the client is telling us, doing a visual assessment, palpating and testing range of motion we can determine the best treatment to give the client.
In this blog we are going to take a look at Thoracic Outlet Syndrome.
Signs and symptoms
Shooting pain, numbness, weakness, tingling in the arm particularly in the wrist and hand, but not always, and possibly a difference in temperature and or color of the arm.
Nerve or blood vessel impingement, in the area behind the clavicle and between the scapula and the humerous called the brachial plexus. The muscles include the trapezius, the sternocleido-mastoid, the scalenes, and the pectoralis minor.
1.) Strip from the skull to the collar bone. Technically you are stripping from origin to insertion over the anterior, medial and posterior scalenes.
2.) Follow this up with deep compression at the insertion of these muscles behind the collar bone/clavicle.
Pectoralis Minor: The client remains supine with the effected arm slightly abducted and bent at the elbow.
1.) The therapist’s fingers slowly penetrate into the muscle tissue under both pecs along the fifth rib (See illustrations)
2.) Move fingers inferior to superior along the muscle ending below the axilla at the coracoid process. Repeat again one more time.
Now add compression. The client is in a side lying position with affected arm over the head. With fingers wrapped around posterior shoulder blade or scapula, the therapist grasps the pec minor with the thumb.
3.) Compress into the pec minor with the thumb until it releases.
Additional treatments can be found in Basic Clinical Massage Therapy by Clay and Pounds.
1.) Laterally flex neck on painful side and flex forearm and wrist to shoulder.
2.) Open fingers and extend arm while keeping neck laterally flexed
3.) Abduct arm parallel to the ground and horizontally hyperextend the arm as far as it will go with palm down, neck laterally flexed
4.) Extend wrist and laterally flex neck to the other side
5.) Flex wrist, adduct arm, laterally flex neck to original side
6.) Return to original flexed position and repeat.
This is one of two Nerve Slide Exercises for Thoracic Outlet Syndrome as demonstrated by Dr. Donald Ozello DC of Championship Chiropractic.
Please attempt this simple exercise and tell us what you experienced.
“Basic Clinical Massage Therapy; Integrating Anatomy and Treatment”, 2nd edition, James Clay & David M. Pounds, 2008.
“A Massage Therapist’s Guide to Pathology”, 3rd edition, Ruth Werner, 2005