Something that is helping my understanding
 

Posting a link to a scientific researcher that actually seems to really understand TOS.

How to truly identify and treat thoracic outlet syndrome (TOS) - Treningogrehab.no

Take notice, tight muscles are weak muscles. Stretching and massaging constantly will likely do nothing in the long term and can be bad without strengthening.

Also "down and back" shoulder position is very bad and he provides good reasoning for that.

Worth a read for anyone looking through here and trying to understand.

I hope the best for everyone going through this and that you may find your answers. I like to share any information I find.

Best.

Hey. you are correct about stretching. though in my experience stretching can allow you to develop a little bit of permanent flexibility in your neck which actually may reduce tightness, but it will never solve anything and also it has a great chance to provoke pain. so only moderate stretching from time to time is good.

Regrading strengthening - yes it can definitely help if your problem is atrophy. again, it will not fully solve the problem but it will reduce symptoms in the long term.

but here is something that is not mentioned in your article:

1) There are actually physical defects in some cases(like mine) of TOS where scalenes
invade places they shouldn't be on - could be on nerves or blood vessels. no exercise is going to fix it, ever. these defects can also do other things like cause pain since they are asymmetrical or sunk in.

2) not all cases are atrophy cases. read about hypertrophy which can cause tightness too. in that case
i doubt sport will help but it again will reduce some symptoms...
if you have athropy though - stretching + strengthening afterwards does help a lot. like in my case. but do not expect full recovery.

3) if you have an extra rib - forget everything you read in that article. any exercise can actually damage you.

again my good sir, in a lot of cases TOS can not be cured with sport. it will come back because the root cause is still there.
that is why im considering surgery, these defects can become far less severe afterwards if you have a genius surgeon.

Best thing for Tos is resting your neck properly... huge tightness relief. Buy a chair with arm + head r est and d lay down on it. Instant relief

What do you mean your scalenes are invading a space?

The idea is that if you didn't have this problem before, and you have it now, something must have happened to cause it. And if you undo the things that caused it (poor posture), weak back, neck, etc, you should be able to loosen up the compression and continue on with life. Yes some people have extra ribs, but still, did they not live life normally up to the point of TOS?

I'm not trying to over simplify TOS, I'm just simply saying it is a slow process that got us here. Mistreating our bodies through repetitive motions, poor posture, etc. If we can undo these habits we might be able to get back to a pain free state.

Doctors make $$ off surgery so it's always a good idea to get a second opinion, however like I've said before, if you are at risk for blood clots or have already had one.. surgery might actually be your best option..

Good luck. Meanwhile I'm gonna keep training and watching my symptoms reduce hopefully.

What do I mean by invading? I don't have a better word for it so I will describe it;
you said that you have weak scalene muscles. they are not just weak,
they have atrophied and in many cases, they have shrunk in size, shifted their physical position into areas of the neck and now compress areas like Brachial plexus or a blood vessels.
training and posture are great. will it fix it in the short term, maybe. long term? that is even a bigger bet. worth the try though. in my case I feel 40% better thanks to training and posture.

That's what I believe has happened to me as well

The thing is, it's taken up til now to get to this point. A couple of months of PT isn't going to reverse it all... Even though we would love for it to, it really seems to take a long time..

40% is really good.. I'm happy for you. I can only hope it continues in that trajectory. I am probably around there as well but I am seeing improvements pretty rapidly. I'm working out harder now than I was and I am avoiding my home computer more which is hard because I love to game.

During the work week it's worse because my job is a desk job.

I still do my work outs daily. Religiously. And twice a week I do more intense workouts, sometimes 3x a week. I have to work hard to make real physiological changes.. it took me a long time to get to this point though. I spent a lot of time being inactive and playing a lot of video games, and not doing a whole lot.

So I've been in pt twice a week since probably about January? I've researched a whole lot of stuff, and ive experimented a lot. Id be interested to know what you are doing for your routine.

Thanks

I pretty much quit my routine already as I already know the greatest thing to do is a proper rest. cure will not come anymore out of my routine.
it pretty much was anterior & middle scalene stretches, + SCM and deep neck flexors strengthening

McKenzie Method: Cervical/Neck Retraction - YouTube

and this which will improve the anterior scalene(use a very thin weight):
How to workout the neck: Weighted Neck Flexion for Sternocleidomastoid Tutorial - YouTube

Do you have any shoulder/shoulder blade mobility issues? Do you strengthen your back muscles? Low/mid/upper traps? Rhomboids? Stretch lats and serratus anterior? Do you do any soft tissue work on yourself? Any thoracic spine extension? Foam roller?

Not in my T.O.S side. beside the T.O.S my left side is fine.
On the right side though... I have levator scapula instability forcing me to go into forward head position most of the time. it has something to do with the shoulders too. i am still researching but so far i found it is giving me headaches & tinnitus & burning right neck. shoulder shrug + cat-cow fixes it temporarily and my symptoms calm down by a lot. i just need how to figure out to make it permanent, but first thing ill deal with my left side T.O.S.

I wonder if your shoulder issue on the right side making you go into your forward head position is causing your scalenes on the other side to be tight causing your TOS??

TOS is so complicated. Hope I'm not over stepping.. just nice to talk to someone that is also going through this puzzling issue.

Stay in touch with how you go.

well both contribute to forward head position - but one thing didn't lead to another. Repetitive mouse motions with both hands caused this 2 separate issues. And the levator scapula is mainly a neck muscle with little roots to the shoulder. Look it up on google and tell me if it's also what's wrong with you.

My issue definitely involved levator scap and upper trap. I spent most of my free time on a computer and my job was doing repetitive motions out in front of my body 8 hours a day. I have terrible posture and forward head. My issue started with pain in the armpit... Then came scapular instability. My scap stability is improving albeit slowly. Basically the pec minor, upper trap, and levator scap were working over time for my job doing the motions out in front of me.

Once they overpowered my back muscles enough my shoulder basically got stuck in that forward position and my shoulder blade had an anterior tilt. This causes all kinds of popping and grinding noises..I know if I can get that shoulder blade to sit back and fix my posture that my symptoms will resolve. It's just incredibly frustrating when you have a few good days and then a really bad one that sets you back.

Have you searched for Pec minor tightness & lymph drainage massage?

You know what they say.. old habits die hard.. well poor posture for a lifetime takes a long time to re train.. it's totally consumed my thinking. My relationships have suffered, my happiness has suffered.. but I will continue to fight this..

Can you do this(shoudler shrug - stand infront of a mirror):

https://www.tinnitustalk.com/attachm...png-png.29319/

Notice both shoulders are almost reaching the ears + they are in one line. are they in one line in yours?
if yes thats one sign for levator scapula syndrome. this is the 2nd sign:

The Killer Stretch! LEVATOR SCAPULAE - Try This For Quick Neck Pain Relief - Dr Mandell, DC - YouTube

can you do this stretch(be precise) without feeling tightness + can you go all the way down like Dr Mandell?

if you failed these 2 tests then you have levator scapula injury.

pec minor - i really dont have any problem with that muscle in my case.

I haven't looked for lymph drainage massage.. I massage my pec minor daily with my fingers or a lacrosse ball. The thing is that it's so hyper sensitive that if I slouch for like a day that sucker just gets so tight again.. I really have to remain vigilant and keep my shoulders back. Otherwise the pec minor just gets tight again and I have to work it back open. When pec minor gets tight my whole right side of the neck gets tight as well.

It's like my nervous system has a learned response to slouching that any time I do it for an extended period I get hit with the symptoms. If I just say screw it and keep my shoulder pinned back an entire day (consciously) my symptoms are minimal but using that arm is difficult.

Jo how are you doing these days? :)

I will try these when I get home. I struggle with shoulder shrugs. My right shoulder lags behind. I think my back on my right side is just generally weak. I have been doing shrugs almost daily now for the past 3 weeks with either no weight or just 3 lbs. My right side is becoming more coordinated as time goes on.

It's a pain in the butt. :eek:

You don't do any of my experiments with force or weights, just until your body starts telling you "hey buddy i can't do this motion anymore".

If pits get puffy & tender that's the lymph system clogged up..
self care vids on youtube for that..

Also try the opposite postures - putting arms back behind your body and holding them many times a day.. ( not to point of pain or if it causes pain...) this helps to offset the forward use aspects..

TOS wise I'm doing pretty good, but getting older brings up past injuries & ache & pains.. some chronic myofascial pain stuff..

That's good Jo, glad to hear. Being organic can suck sometimes. The arms behind the back is a good one. I have to try to remember to do that regularly as well as stand up and move around, stretch etc. Thank you.

Does your arm start hurting if you don't move around from the chair?
weird thing about my case is that my arm is barely affected(except cold hands) - only when I use it to carry heavy things around I feel weakness + pain in my median + ulnar nerves. but I can sit for hours without getting any arm pain. but from the neck up above I can get just about anything...

Oh yeah. I think my back muscles begin to fatigue when trying to sit in proper posture. I always want to lean to one side and use my arm as a crutch. I think this is what really did it for me. Having a weak core and lower back caused me to lean to one side on an arm rest. That side became weak. Then I spent way too much time on the computer in that position. Then I went into a job where I had to stand and use my hands in front of me all day. Muscles hot fatigued, burned out and eventually my shoulder just sort of collapsed down. My right shoulder does not like to retract. If I hold my arm out at 90 degrees and bend my elbow up at 90 degrees and try to rotate from elbow to hand down Infront of me that is where I am limited in motion. To make the full rotation my shoulder rolls forward. It's like my joint is really limited in that specific movement as well as my shoulder doesn't want to stay elevated and keep that space open. It's like my back muscles that keep the shoulders pull back and down gave up or something. My main goal is to try and make my back stronger and keep stretching out my chest. Strengthen my neck muscles so that they can also bare the weight of my shoulder as well. For instance.. the SCM connects to your collarbone and sternum. You need to have a strong SCM to keep these lifted as well as have healthy scalenes that can allow your ribs to move up and down normally. So strengthen back, romboids, upper, mid, lower traps, strengthen neck (chin tucks, neck curls) stretch chest, pec minor, lay on towels rolled up length wise, doorway/corner stretch, and many others. Soft tissue release with a lacrosse ball is great too. Dry needling for pec minor is nice.. idk I'm just sharing ideas. Not saying it's wrong or right but this is kind of where I am at right now. Trying not to overdo it and be conscious about how I sit at work.