You Should Read This Article If:
- You ever feel seemingly unprovoked numbness or tingling through your arms, hands, or fingers
- You ever feel seemingly unprovoked pain in your arms, hands, or fingers
- You’re a personal trainer, strength coach, or anybody that deals with the human body
- You like reading about anatomy
Thoracic outlet syndrome is becoming a common diagnosis in doctor’s offices and with good reason. Since the development of offices, chairs, and computers, our population has made it a point to situate our heads as far forward on our torso as possible. This is called forward head posture and can contribute to a whole host of issues, not limited to just thoracic outlet syndrome.
Once you’ve ruled out other issues like congenital defects, bone malformations, diseases, and traumatic episodes, thoracic outlet syndrome becomes an umbrella term to describe pain, numbness, and tingling throughout the upper extremities. It is often confused with overuse injuries, tendinitis, and other conditions like carpal tunnel.
Thoracic outlet syndrome is caused by the compression of nerves and blood vessels somewhere along the chain and can cause symptoms as far down as your fingertips. Frequently, thoracic outlet syndrome (TOS) occurs because of interference from the scalene muscles (in your neck), clavicle (collarbone), or 1st rib. When things are out of alignment, other things become compromised. In this case, it is your nerves and blood vessels and it can become a very uncomfortable situation.
TOS is frequently exacerbated by poor posture because the nerves and vessels pass between (and sometimes even through) the scalene muscles of the neck.
When you sit staring at a computer or cell phone all day with your head poked forward, you tend to tighten up the muscles throughout the back of the neck, but might also find yourself with some overactive scalenes. As you develop trigger points through the scalene muscles, they might start to piss off the nerves and blood vessels that are passing adjacent to them.
Improper breathing mechanics can also lead to TOS symptoms. When we don’t use our primary breathing muscles (abdominals, obliques, diaphragm) correctly, accessory breathing musculature like the scalenes and sternocleidomastoid become overactive to compensate and help us inhale.
Not only could these muscles develop trigger points (see below), this type of “neck” breathing could elevate the clavicle and 1st rib and interfere with the nerves and vessels nearby.
Before you jump to any conclusions regarding your TOS symptoms, try addressing your breathing mechanics. Some deep breathing exercises peri-workout and throughout the day could help.
Another common cause of TOS is scapular instability. This means your shoulder blades don’t move correctly.
Since the shoulder blade connects to the clavicle at the acromioclavicular joint, a scapulae that is anteriorly tilted, internally rotated, or downwardly rotated could potentially cause a situation where the collarbone interferes with the nerve and blood vessel bundle that passes underneath.
This would cause tingling, pain, and numbness in the fingers. The fix for this is, assuming your thoracic spine checks out and you don’t look like the hunchback of Notre Dame, is improving the way your shoulder blades move and how they sit on the back of your ribcage.
The fourth (and what I believe to be the most common) reason for TOS symptoms is trigger points throughout different muscles in the upper back and shoulder region.
The current theory is that trigger points develop as small cramps in a muscle that is being over-used. This is similar to how your hamstring might cramp during a glute bridge, but on a smaller scale.
Relating back to my second cause of TOS, trigger points in the scalenes can bother the nerves and blood vessels that pass between them.
But trigger points underneath the shoulder blades (serratus posterior superior muscle) and just beneath the shoulder blades (teres major, teres minor, lats) can both contribute.
*I suspect this is because a functionally short serratus posterior superior muscle may cause the first rib to elevate and interfere with the nerves and vessels in some people. Teres major and minor, on the other hand, probably cause issues with the nerves and vessels passing through them. The lats downwardly rotate the shoulder blades (especially for those that have a scapulae-lat attachment point), causing interference from the clavicle.
If you’ve made it this far, congrats!
If you’re still unsure of what to do in the case of your tingling fingers, here’s a quick order of operations. In all actuality, you could try all of these things at the same time. Just make sure you give each a fair shake before you jump to conclusions and equate your tingling fingers with being a wizard that has carpal tunnel.
You are not a wizard, Harry.
- Self myofascial release for your lats, teres group, and mid-back muscles.
- Myofascial release (a.k.a. massage) from somebody qualified on your scalenes and neck musculature.
- Fix your posture.
- Fix your shoulder blades. If your collarbone is flat or slopes down, it should be rotated up more.
- Fix your breathing. It should be diaphragmatic 60% of the time, every time.