Nice article - I'll add it to our chiro links section.

I found these parts very interesting- my chiro does most of these suggested tx's -

[In addition, he suggests, the doctor of chiropractic can do a first-rib adjustment to create space so that the plexus isn't compressed. "You can also do some cross-cord exercises, making the contralateral scalenes contract and the muscles of the other side relax. Myofascial active release is also effective."

Dr. Saboe also recommends deep-tissue work for the trigger points. "I do digital pressure, cross-frictional massage, and origin and insertion work-which means doing friction massage of the origin of the scalenus muscle and the insertion-with hopes of stimulating the tendon apparatus so that the muscle relaxes," he says. "Many times I also use interferential, high and low mode, for 20 minutes after an adjustment and before the soft tissue work, to try to loosen up all the musculature. If there are truly active trigger points in the scalene musculature, the latissimus dorsi and superspinatus, pulse ultrasound in combination with negative galvanic electrical stimulation is very beneficial."]

[Dr. Tyer also advocates assigning patients an exercise plan. "Extensor exercises, for example, are good, "You want to strengthen the extensor groups of the neck. When you do that, the flexors have to inhibit, they have to release. If the thoracic outlet syndrome was not caused by trauma, it's often caused by poor posture-certain muscles are starting to contract because their extensor groups are weak," he says. "When someone presents with anterior rotated shoulders and the head carriage is forward, everything's closing up in the anterior group and the extensor groups become weakened. Extensor exercises can help take care of some of these anterior contractures."]

["In my experience, you don't cure thoracic outlet syndrome, you manage it," says Dr. Saboe. "You give symptomatic relief, and the symptoms will slowly return, although in every case I've seen, they never return as intensely as they were before-provided it's managed properly. If the patient comes back in, that patient will respond to palliative and supportive treatment. I haven't had a single case that's progressed or gotten worse. The only cases I've ever heard of that have deteriorated are those in which the first rib was resected."

Once the initial presentation of TOS is resolved, Dr. Murphy recommends that the practitioner look for underlying factors that may serve to perpetuate the problem or promote its return. "These may include cervical or scapular instability residual joint dysfunction in the cervical or thoracic spine, and any residual neural tension that can be detected through the brachial plexus tension tests," he says.

For long-term management of thoracic outlet syndrome patients, Dr. Saboe also recommends supplementing with B complex. "In addition, if patients are really acute, I also use enterically encoded proteolytic enzymes," he says. "They're natural anti-inflammatory agents."]