Do you have tingling or numbness in your hand that goes beyond your first three fingers? Do you have weakness in your forearm, arm or shoulder despite your weight training routine?
It’s not carpal tunnel since it involves more than the fist three fingers. And you have no history of neck problems, all orthopedic tests and X-rays/MRI of the neck are negative.
You might have an entrapment syndrome of the brachial plexus nerves or subclavian artery/vein to the before mentioned structures.
This entrapment syndrome called Thoracic Outlet Syndrome is caused by three major conditions; Anterior Scalene Syndrome, Costoclavicular Syndrome and Pectoralis Minor Syndrome as well as some minor causes.
In the first condition called Anterior Scalene Syndrome, the brachial plexus nerves arising from C5, C6, C7, C8 & T1 nerve roots is trapped between the anterior and middle scalene muscles which may be in spasm or compensating for inhibited neck muscles.
This can be assessed by palpating for a decrease in strength of the radial pulse at the wrist. The patient is asked to ipsilaterally rotate, contralaterally laterally flex, and extend his neck at the spinal joints, while the radial pulse is palpated; this called Adson’s Test. Decrease in strength of the radial pulse is positive for the syndrome.
Treatment consists of using spindle work on the bellies of the scalene muscles or golgi tendons of the scalene attachments and of balancing the other neck muscles which can be either inhibited or compensating.
In the second condition Costoclavicular Syndrome, the brachial plexus and subclavian artery and vein run between the first rib and clavicle in the medial pectoral region. If the posture of the relationship of the clavicle and first rib changes and they approximate each other as often happens with rounded and slumped shoulders and impingement may occur.
This can be assessed by palpating for a decrease in strength of the radial pulse at the wrist when the patient is asked to stick his chest out and pull the shoulder girdle back and down similar to the military posture of attention. Again, weakening of the strength of the radial pulse would be considered to be a positive sign. This is called Eden’s test.
Treatment consists of checking muscles such as the SCM and the subclavius that attach to the area, improving the patient’s posture and checking muscles that resist this bad postural pattern such as the rhomboids and the middle trapezius.
In the third condition Pectoralis Minor Syndrome, a tight pectoralis minor muscle compresses the brachial plexus and/or subclavian vessels against the rib cage. The assessment is to bring the patient’s arm up and back. This position called Wright’s Test stretches and pulls the pectoralis minor taut against the rib cage
Treatment consists of checking for either an inhibited or facilitated pectoralis minor, or other muscles that can be inhibiting or compensating such as the serratus anterior, latissimus dorsi or the lower trapezius.
Other minor conditions such as when both the medial and ulnar nerve getting entrapped by a spastic muscle such as the pronator or by a misalignment of the radius and ulna bone can happen and need to be ruled out.
For additional information, please check out: https://drvittoriarepetto.wordpress.com/2015/09/20/a-nyc-chiropractorapplied-kinesiologist-starts-adding-neuro-kinetic-therapy-to-the-mix/
© 2015-Dr. Vittoria Repetto
© Revised 2016 – Dr Vittoria Repetto
Want more information on Dr. Vittoria Repetto and her NYC Applied Kinesiology/Chiropractic/ NKT practice at 230 W 13th St., NYC 10011; please go to www.drvittoriarepetto.com
And please check out the Patient Testimonials page on my web site.
Want to be in the know on holistic information and postings?
Or join me at Twitter: www.twitter.com/DrVRepetto