I see patients diagnosed with Carpal Tunnel Syndrome, Shoulder Pain/Frozen Shoulder, Tendinitis and a whole raft of other conditions that actually have Thoracic Outlet Syndrome (TOS). The patients I feel for are the ones that have had surgery for their diagnosis and still have the same problem.
TOS is a condition that Chiropractors are expert in as it involves the nervous system, the spine and the tissue associated with it.
What is it
At the base of your neck there is an area where a lot of nerves (brachial plexus), arteries and veins leave your spine and head towards your shoulder and arm. This area is particularly vulnerable to damage or irritation. When it is irritated pain can be felt as shoulder pain/frozen shoulder, pain in the arm and even carpal tunnel like pain. Research now shows that it is more typically a problem of nerves rather than blood supply 
What Causes It
There are a few common causes
- Accidents that affect the area, especially fractures of the collar bone.
- Posture – People with rounded forward shoulders, tight chest muscles, heads that protrude forward and Gothic shoulders (the muscles between the shoulders and the neck form triangles that look like a Gothic Church Arch) are all possible causes
- Muscle development – People with muscles that expand into the vulnerable area and start compressing the nerves. As well sports people or workers who are either lifting things above their heads or having their arms above their heads are vulnerable.
- Cervical Rib – There is a relatively common condition that some of us are born with an extra small rib that sits at the bottom of the neck. This rib can dig into the structures.
Places that are typically affected
- Between the anterior and middle scalene muscles
- Underneath the pectoralis minor muscle
- Between the uppermost rib and the clavicle
Tests helpul in Diagnosing Thoracic Outlet Syndrome
- brachial plexus tension test
- cervical compression test
- cervical rotation test
- Roos Test
- Costoclavicular Maneuver
- Allen Test
- Muscle testing for weakness
- Sensation testing for numbness/reduced sensation
- The best is a detailed medical history which usually gives a pretty clear indication
Most Typical Symptoms
- Numbness in the hand – especially the little finger
- Numbness in the forearm
- Waking with numbness in arm or hand
- Neck Pain
- Shoulder pain
How do we Treat It
- Manipulation of the neck to reduce nerve irritation and restore the natural curve of the neck
- Adjustments of the first rib and collarbone to open out the space
- Treatment of the fascia or connective tissue
- Specific Stretches aimed at correcting posture
- Changes in habits/activities that are irritating or producing the symptoms
- I have found a few specialised Muscle Energy Techniques that produce amazing results in my TOS patients
The most important thing is to get a precise diagnosis before considering treatment. It is important to know the real cause of your problem to develop a treatment that resolves it. TOS is a condition that responds especially well to Chiropractic Treatment.
 Rayan GM. Lower trunk brachial plexus compression neuropathy due to cervical rib in young athletes. Am J Sports Med 16,1988:77-79.