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Feldenkrais Method
Thoracic Outlet Syndrome

Thoracic outlet is the diagnosis given to pain, numbness and weakness of the arm/hand that is caused by compression of nerves and or blood vessels, which travel from the chest to the arm. Different target tissue may be causing the compression:

Pectoralis muscle may be tight, compressing the neurovascular bundle as it stretches across the chest to the shoulder.

The collarbone may be dropped down either from asymmetrical posture or carrying heavy bags. Women may experience compression from the weight of large breasts on both collarbones.

An extra rib on the 7th cervical vertebra may be pressing on nerves or blood vessels as they exit the spine.

The scalene muscles which lift the first two ribs may be tight, hence cause the neurovascular bundle to be pinched between the collarbone and ribs or the scalenes themselves can pinch nerves that run through them.

Over-retraction of one's shoulders (military posture) can create compression of the neurovascular bundle between the collarbone and ribs. Add the downward compression of a backpack and you've increased the risk.

See Tho 1 and link

Diagnosis: Various test can be performed which try to reproduce symptoms and or decrease one's pulse in the affected limb. They are similar to the provocative motions/positions listed above. Tingling in the hands can occur when compression is release by lying on one's back. Doctors will often perform x-rays, nerve tests and blood flow studies.

Conservative Treatment Approaches are to:

Normalize an elevated rib if found. I use positional release for this and it works. Improve posture and habits contributing to the compression.

Reduce the carrying of heavy and or asymmetrical loads (this included a backpack over one shoulder, or wearing a very heavy backpack on both shoulders).

Avoid sleeping on your side with your bottom shoulder higher than 90°. Do not sleep on your back with arms overhead.

Normalize scalene and pectoralis muscle elasticity and tone before stretching them with Kurashova Tissue Re-education Techniques.

Ensure structural symmetry. See NUCCA.

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MovementWise Christine Inserra P.T.
Certified Teacher of the Alexander Technique & Feldenkrais Method
Physical Therapy serving Chicago and the Greater Chicagoland Area