This is my theory of the sequence of events and the subsequent physical responses which make up the condition Thoracic Outlet Syndrome.

In the beginning there is a wry neck or whiplash symptoms.
The sufferer has difficulty lying on the affected side.
The sufferer has altered sensations in the hand and arm on the affected side.
Some of the symptoms are made worse when sitting.
Some of the symptoms are made worse when the affected arm is used, the higher the arm is held the worse the symptoms. The longer the arm is held in a pose the worse the symptoms become.
There are many muscle spasms in the upper back.
The symptoms are inconsistent. Sometimes the affected arm feels very heavy.
Sleeping becomes disrupted. The sufferer’s breathing pattern changes. The sufferer feels very tired and no longer is able to perform physically as well as they used to. As the condition worsens more postures will provoke the arm symptoms. Lying on the opposite side will cause symptoms in the affected arm.
Pain radiates from the lower neck up the back of the head and causes debilitating headaches.


Quite simply the current understanding of the condition is not one which is able to help many sufferers improve their situation, the current understanding makes many sufferers worse. The current understanding attempts to explain its inability to help some sufferers by diagnosing the sufferer with illness behaviour.

I believe what occurs is,
• The wry neck not only temporarily compromises the brachial plexus but also compromises nerves to muscles which affect scapular stability.
• The scapular instability would normally resolve, but if the affected person is in an occupation which requires extraordinary arm use (and therefore extraordinary scapular stabilization), compromise to the nerves which innervate scapular stabilizing muscle continues and secondary compromise occurs (bowstringing of the long thoracic nerve)
• The neural compromise and the overuse of compensatory scapular stabilizers precipitates thoracic spine tightness in the same area where it is possible that the cause for the wry neck originated.
• Chest breathing compounds the neural compromise problem
• Rehabilitation programmes attempting to strengthen neurally compromised muscles exacerbate the nerve compromise problem.
• Non-steroidal anti-inflammatory drugs (NSAIDS) cause breathing problems in some individuals
• Pain relief will mask actions and postures which compromise the affected nerves
• Whilst sleeping the sufferer unwittingly compromises the brachial plexus and the nerves which control scapular stability.
• Sleeping whilst chest breathing makes the situation much worse
• Using medication to aid sleep causes the sufferer to sleep whilst compromising the affected nerves.
• The sufferer feels exhausted and ill to the point where they spend more time lying down or sitting- the situation is a downward spiral.
• Invasive medical procedures borne from misconceptions of the process of compromise to the brachial plexus a) cause significantly more problems than they resolve and b) do not address the root cause of the problem (scapular instability)

It is important to treat the causes of the problem rather than the symptoms. Once the root cause of the problem (wry neck) has gone, the subsequent cause is scapular instability. If one can focus on minimising actions which make the scapular stability worse, (lying on a chest breathing rib cage, using the affected arm up high or far from your body, sitting and holding postures which require continuous scapular stability, reaching down to do up shoelaces etc., etc.) the body will try to heal itself. Thanks for reading this regards Towelhorse