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"My Arms Fall Asleep" - Thoracic Outlet Syndrome

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MuscleHead
Sep 9, 2010
3,441
643
#1
Here's an article I came across while researching a condition I seem to be having lately. Let me know if you've experienced anything similar...


here is a little about TOS:

Definition
Thoracic Outlet Syndrome (TOS) is pain, numbness, tingling, and/or weakness in the arm and hand due to pressure against the nerves or blood vessels that supply the arm. It is due to tight muscles, ligaments, bands, or bony abnormalities in the thoracic outlet area of the body, which lies just behind the collar bone. Pressure on the nerves is the problem more than 95% of the time, but occasionally the artery or vein is involved.

Common Symptoms
The most frequent complaints are numbness and tingling in the fingers; pain in the neck, shoulder, and arm; headaches in the back of the head; weakness of the arm and dropping things from the hand; worsening of the symptoms when elevating the arm to do such things as comb or blow dry one's hair or drive a car, and coldness and color changes in the hand. The symptoms are often worse at night or when using the arm for work or other activities.

Cause
TOS is most often produced by hyperextension neck injuries. Auto accidents that cause whiplash injuries, and repetitive stress in the workplace, are the two most common causes. Some of the occupations that we see causing TOS include, working on assembly lines, keyboards, or 10-key pads, as well as filing or stocking shelves overhead. In some people, symptoms develop spontaneously, without an obvious cause. An extra rib in the neck occurs in less than 1% of the population. People born with this rib, called a cervical rib, are 10 times more likely to develop symptoms of TOS than other people. However, even in people with cervical ribs, it usually requires some type of neck injury to bring on the symptoms.

Diagnosis
Physical examination is most helpful. Common findings are tenderness over the scalene muscles, located about one inch to the side of the wind pipe; pressure on this spot causes pain or tingling down the arm; rotating or tilting the head to one side causes pain in the opposite shoulder or arm; and elevating the arms in the "stick-em-up" position reproduces the symptoms of pain, numbness, and tingling in the arm and hand. There is often reduced sensation to very light touch in the involved hand (this can only be detected in people with involvement on one side).

Diagnostic tests, such as EMG's or NCV's, may show non-specific abnormalities, but in most people with TOS, these tests are normal. Neck or chest x-rays may show a cervical rib. Loss of the pulse at the wrist when elevating the arm or when turning the neck to the side (Adson's sign),has been thought by some to be an important diagnostic sign. However, we find it unreliable because many normal people also lose their pulse in the same positions, and the majority of people with TOS do not lose their pulse in these positions. Shrinkage of hand muscles (atrophy) occurs in about 1% of people with TOS, and these people will have nerve tests that show a typical pattern of ulnar nerve damage.

Disease Process
Microscopic examination of scalene muscles from the necks of people with TOS demonstrates scar tissue throughout the muscle. Presumably, this was caused by a neck injury stretching these muscle fibers. The tight muscles then press against the nerves to the arm (brachial plexus) producing the hand and arm symptoms. Neck pain and headaches in the back of the head are caused by the tightness in these muscles.

Treatment
Treatment begins with physical therapy and neck stretching exercises. Abdominal breathing, posture correction, and nerve glides, carried out on a daily basis, are a part of the therapy program. Gentle, slow movements and exercises are stressed. Methods like Feldenkrais have helped many people with TOS. Modalities to avoid are those that emphasize strengthening exercises, heavy weights, and painful stretching. It is important to be examined and tested for other causes of these symptoms because other conditions can coexist with TOS, and these should be identified and treated separately. Some of these associated conditions include carpal tunnel syndrome, ulnar nerve entrapment at the elbow, shoulder tendinitis and impingement syndrome, fibromyalgia of the shoulder and neck muscles, and cervical disc disease. Surgery can be performed for TOS, but it should be regarded as a last resort. Non-surgical forms of treatment should always be tried first.

Results of Treatment
Most people with TOS will improve with stretching and physical therapy. The improvement rate with surgery varies with the cause of the TOS. Auto injuries have a success rate of 80-85% while repetitive stress at work has a success rate of 60-70%.

ARTICLE WRITTEN BY: Lauri Ordway
 
omni

omni

Member
Jan 29, 2011
59
3
#2
I wake up with both of my arms asleep and it gets worse the bigger I get. I took a few years off and the problem was gone. My size is back and so is the numbness.
 
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