Thoracic Outlet Syndrome
Ross Hauser, M.D.

The thoracic outlet consists of the space between the inferior border of the clavicle and the upper border of the first rib. The subclavian artery, subclavian vein, and brachial plexus nerves (the nerves to the arm) exit the neck region and go into the arm via this space. In Thoracic Outlet Syndrome (See case history) (TOS), the space is, presumably, narrowed, causing a compression of these structures. The symptoms of TOS include: pain in the neck, shoulder, and arm; coldness in the hand; and numbness in the arm and hand. However, in severe cases of compression of the subclavian vessels, Raynaud’s phenomenon, claudication, thrombosis, and edema can occur in the involved extremity.

TOS is a legitimate condition and does occur but its prevalence is extremely rare! Most people who come to Caring Medical, in Oak Park, Illinois, with the diagnosis of TOS leave with other diagnoses such as glenohumeral ligament sprain, Rotator Cuff tendinopathy, cervical ligament sprain, or Slipping Rib Syndrome. All of the pain and numbness symptoms of TOS can occur from these later four conditions, all of which respond beautifully to Prolotherapy.

The reason it makes sense that Prolotherapy would be BENEFICIAL for the symptoms of so-called "TOS" is the fact that the condition almost exclusively occurs in women with long necks and low-set droopy shoulders. Activities that involve abduction of the shoulders, such as combing the hair, painting walls, and hanging pictures, cause worsening of the symptoms. Passively abducting the arm (having someone do it for the person) relieves the symptoms. In other words, when the shoulder is actively raised over the head (the person does it themselves) the symptoms of pain and/or numbness down the arms occur, however, when the exact same movement is done passively (by another person) the symptoms do not occur. This type of symptomatology is a perfect description of ligament and tendon weakness (laxity). The injured ligament and tendon give localized and referral pain when doing strenuous movements, but when someone else takes the brunt of the force, no such symptoms occur.

"The doctor said I have Thoracic Outlet Syndrome and I need surgery to give the nerves more room.” The people with so-called TOS almost unanimously have normal reflexes and nerve conduction studies. This gives further indication that a nerve is not getting pinched. Furthermore, surgically slicing structures to give the nerve more room will not eliminate the symptoms the person is having and could, quite possibly, cause more problems. In my opinion, the person needs Prolotherapy to the pain-producing structure(s), Prolotherapy to the neck ligaments, shoulder ligaments and tendons, or to a rib that is slipping.