Thoracic outlet syndrome

Thoracic outlet syndrome

According to my Injury classification system, Thoracic outlet syndrome usually develops because of misalignment pattern at of the shoulder complex, therefore is considered Level 1 Injury, as per the main dysfunction being found at the first Alignment protective layer with associated nerve entrapment. Is Important to highlight that the nerves described in at his syndrome have the origin at the level of the spine, hence, neck evaluation and treatment should be incorporated when dealing with patients with any shoulder neurological complaint. 

The thoracic outlet syndrome is a constellation of symptoms caused by an irritation of the spinal nerves and brachial plexus as it passes from the neck down to the arms. Patients reports generalised pain and neurological disturbances (pins and needles and numbness) at the shoulder, arm, or hands.

Thoracic outlet syndrome Common compression sites

1 – Neck dysfunctional misalignment; the origin of the nerves that contributes to this syndrome starts at the level of the neck.

2- Compensatory Scalene muscles hypertonicity; After exiting from the neck, corresponding nerves passes between to small muscles located on the side of the neck

3- Elevated first Rib; Due to the hypertonicity of the scalenes, the first rib is raised casing a direct irritation of the nerves.

4 – Pectoral minor compression caused by an anterior fixed shoulder posture misalignment, as a result of a series of compensation patterns of shoulder misalignments, this fixed postural shoulder misalignment creates a shortening of the pectoral muscles resulting in a narrowing where the nerves passed

Chronic injuries at the shoulder may also narrow the nerve passage due to the scar/fibrotic tissue at the superficial fascia and by the osteophytic bone formation from the underlying bones.



The entire lower extremity biomechanical chain must be evaluated as part of the hip neurological analyses as per the neurological and mechanical influences of the spine, elbow and hand.

Clinical assessment of the shoulder/neck misalignment compression sites

Neurological examination.

 X-ray analysis

Anterior – Posterior (AP) X-ray shoulder view is essential to check the overall alignment of the shoulder complex

MRI analysis

Important exam to verify the level of narrowing of the nerve passage and the exact point of irritation

Rule out any other condition; There are rare disorders that may create similar patterns of dysfunction, is advisable to rule out these conditions prior to the start of the treatment.


Treatment protocol

Restore the biomechanical alignment of the entire shoulder complex

Neuromobilization techniques may be used once the direct compression of the nerve is reduced.

Specific therapeutic essential oils are applied to reduce nerve inflammation and enhance healing.

Depending on the level of nerve compromised and chronicity of the misalignment a minimum of 6 weeks up to 12 weeks of treatment care may be necessary to resolve this deformity.

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