The Anatomy of Thoracic Outlet Syndrome: Arm Motion & Thoracic Outlet Syndrome

Join Dr. Scott Werden for a free, online and in depth discussion regarding the motion of the arm and the TOS diagnosis.
Dr. Werden is a nationally known thought leader regarding TOS and has been assisting patients for over 20 years to understand the disease. He encourages patients to develop a strong understanding of the disease so that they can partner closely with their physicians to develop better pathways for wellness.
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i'll go through the presentation about arm motion and tos and i'll come back live like this and we'll welcome any questions or comments
arm motion and thoracic outlet syndrome
we're going to discuss and review the anatomy of the thoracic outlet for those of you who have seen some of my previous talks the anatomy section will be a review but for people who are viewing for the first time this will be an introduction without too much detail should be easy to follow for non-medical people next we'll discuss how arm motion affects the thoracic outlet and finally we'll discuss how these changes in arm motion cause tos it's very important to know this material tos is a form of an entrapment neuropathy we get these all over the body carpal tunnel syndrome for one you've probably heard of but the thoracic outlet and tos are unique because this arm motion creates a really complex extra factor that doesn't just entrap the nerve but can do it in many different ways depending on the person their anatomy their musculature etc
first let's go over some of the key points of the anatomy of the thoracic outlet so what is the thoracic outlet well we've got the natural intrinsic structures of the thoracic outlet we'll take a look at these with some graphics they include the side of the cervical spine the top of the chest the beginning of the shoulder the rib the collarbone the traversing structures are the structures such as the brachial plexus a big nerve bundle the subclavian artery the artery that provides almost all the blood flow to the arm and the subclavian vein the vein that drains almost all of the blood flow from the arm when these structures cross the thoracic outlet they can be affected and when they are affected and they result in symptoms you get thoracic outlet syndrome we also have a series of at least three tunnels as they're classically described by doctors and you've probably heard of these the scalene triangle is one these tunnels are a result of the anatomy of the thoracic outlet and they change in different patients and with different arm positions finally we'll talk about the dynamic changes or the arm motion that's the key point of this talk so the intrinsic structures of the thoracic outlet would be bones muscles lung and other soft tissues such as ligaments here are the basic bony structures we need to know the cervical spine or the neck the first rib at the top of the rib cage which has 12 ribs on each side the clavicle or collar bone as it's commonly called and the scapula or shoulder blade we'll talk in particular about the collarbone the clavicle and the shoulder blade the scapula don't be confused by these medical terms i'll try to use the regular plain english terms i learned as a kid make it easy for all of us let's start out by looking at some of the muscles once the nerves leave the thoracic spine once the artery and vein leave the chest they enter the thoracic outlet and they pass between a series of muscles the most important muscle is the anterior scalene muscle shown here we're not going to discuss the anterior scalene muscle in any great detail for today's talk but you'll be able to see a picture with the anterior scalene muscle and the middle scaling muscle and these two muscles define the scalene triangle there's the anterior scalene in front and the middle scaling in back and between them we get this space which will outline in purple here and that is the scalene triangle you notice that won't change much with neck position or arm motion it's pretty tight and pretty fixed but once the nerves and the blood vessels pass through the space they're going to enter the next tunnel which is a bony tunnel that's called the costoclavicular interval don't worry about the name it's not important but what is important is that you can see the first rib and the bone and between those two bones is a bony space that's the second tunnel that the nerves and blood vessels have to go through remember the pathway of these nerves and blood vessels is to either leave the neck and chest and go to the arm or return from the arm and get to the neck and chest so anything that strucks them or presses on them

[@bubba8289]

Thank you Dr. Werden! So grateful for your effort!

[@arleneportsmouth1263]

👏🏻👏🏻👏🏻 Thank you so much for providing such in depth information regarding this condition. I have been told by several chiropractors since the 90's that they could surmise my pain is from TOS after reviewing my imaging. I had several incidents of battery which damaged my Cervical spine and shoulders from being beaten and thrown down the stairs at my own home. The extended abuse has caused me CONTINOUS SPASMS, Transient Ischemic episodes and Seizures from the nerves being pinched because the muscles are in constant spasm. I have not been able to turn my head since I was 20, before the incidents began. I spend most of the day ATTEMPTING to get out of pain and get circulation back to my arms and hands. I grab my elbow and jam my fist into my clavicle to relieve migraine headaches and restore my vision. I hear popping sounds every time I press on a muscle in clavicle region. I hope to find a specialist who can help me to restore some mobility so I can move my head without turning my body. I will proceed to watch more of your channel and I did subscribe.

[@tosmri]

Hi, Arlene-So sorry to hear about all you are going through. If you would like to consult us in a private manner, reach out at www.tosmri.com/thoracic-outlet-syndrome-education/contact-us/

[@christinemiller230]

Thank you

[@GermanL-ys4kk]

also which is the name of the study about no correlation between adson test and plexus compression?

[@alariskincare8505]

So if we can fix abnormal muscle around shoulder blade causing tos symptoms can go away correct .

[@tosmri]

Hi, @alariskincare8505 Yes, abnormal muscle balance and tension may make the shoulder blade or collarbone move abnormally relative to the first rib. This can cause compression of the brachial plexus, resulting in symptoms of neurogenic TOS. You are correct, in that some cases of TOS can be resolved by resolving the muscle imbalance. However, in some case of TOS, that may not be enough, and surgery may be indicated.

[@vikkiprevette2934]

Do you have a picture of blood clots in hands or necks? With TOS

[@Tinks574]

Thank you so much Dr Werder. I am currently under investigation for TOS following being hit by a car when riding my bike. The crash resulted in a broken Olecranon and a second break in the elbow, a broken wrist and broken rib along my back. Since then I have been diagnosed with a collarbone that dislocates (Subluxing) at the SC joint. My fingers go numb and my hand often looks blue/grey. As time has gone by, the other collarbone has started to loosen and shift out of joint. The consultant I am seeing is investigating TOS, but feels the subluxing SC joint is a problem. There is so little literature about the combination of the two... do you have any words of advice on what I can ask the consultant?

[@tosmri]

Hi, @Tinks574 There are clinical tests a TOS specialist would perform, moving your arms and neck to reproduce symptoms. If these are positive, they could consider dedicated imaging, such as we do. Anything that causes abnormal clavicular movement may cause compression of the brachial plexus. For more specific info, reach out to us on www.tosmri.com.

[@morefastmoredates9444]

Harold Finch

[@GermanL-ys4kk]

Can you share the name of the study you talk about in 32:23?

[@tosmri]

Demondion et al 2003 'Thoracic outlet: assessment with MR imaging in asymptomatic and symptomatic populations'

[@ashleysoleimani3468]

Hi! How do I go to you? I live in Loa angles

[@ashleysoleimani3468]

Los Angeles

[@tosmri]

@@ashleysoleimani3468 We have an imaging partner in the Greater LA area. Please contact us at www.tosmri.com/contact-us/

[@kochupal289]

I am from kerala, India.I have bilateral cervical rib and TOS problems, like both side of back neck pain,between shoulder blade radiating to both shoulders, elbow and toes.some times to sternum. I have thoracic area tenderness and pain.Dr, is Ayurveda treatment like body massage ,heat application, cervical traction helpfull? What exercise good for me, please give replay. Thank you.

[@tosmri]

Hi @kochupal289 Thank you for pointing out that many of these modalities can help some patients. Thoracic Outlet Syndrome is complicated, though, so what works for one person does not work for all. I hope you have a thoracic outlet syndrome specialist helping you.