Thoracic Outlet Syndrome/First Rib Syndrome

           “Doctor, I have pain and numbness down my arm!”

            As a physician, we first have to rule out the possibility of a stroke. We look and ask for any symptoms of weakness on one side, slurred speech, and difficulties in speech, either speaking or hearing and understanding the words. If the neurological findings only affect one arm, ascertain whether the ulnar, medial, or radial nerve is affected.

            The ulnar nerve controls sensation in the dorsal pinky and half of the fourth finger. The rest are controlled by a combination the radial and medial nerve.

            Many people with first rib syndrome or thoracic outlet syndrome get misdiagnosed as carpal tunnel or ulnar nerve entrapment. The latter two may require surgery.

            If they figure it out as thoracic outlet syndrome, if the symptoms are severe and are both neurological and vascular in nature, they might advocate surgical removal of the first rib, which is a relatively difficult procedure.

            An osteopathic physician can offer a nonsurgical options.

            But why does the arm go numb?

            The first rib attaches to an articulation on the transverse process of T1, a suction cup like joint, and in certain movements, like pulling something heavy from a top shelf, talking on the phone using your neck to hold up the phone, or sleeping on the sofa and using the armrest as your pillow, sleeping with your arm overhead or even sleeping on the plane and hitting severe turbulence can knock the first rib out of its articulation. Each action above can pull the first rib had away from the neck, and sudden forces can “pop” the rib out of the socket.

            The brachial plexus, the nerves that innervate the arm, come out just above the articulation of the first rib. When that happens the neck muscles which include the scalenes and the platysmus stress out, tighten, and pull the rib head up even further into the brachial plexus.

            Why is that important?

            The brachial plexus is comprised of nerves originating from the middle of the neck to the top of the thorax to join together as a conduit that supplies the nerves to the arm. The brachial plexus normally exits above the first rib head. So if the first rib is raised up, it pushes directly into the brachial plexus, causing pain and pins and needles down the arm, known as paresthesias.

            This can be accentuated by raising the arm up above the shoulder, or by sleeping on the affected arm. Both actions cantilever the first rib head up so that if press is harder on the brachial plexus and causes more symptoms.

            Luckily, there are many ways to osteopathically “fix” a first rib.

            Now, thoracic outlet syndrome is actually very common, much more than reported by UptoDate, and within months of discovering these new techniques, I was able to use them successfully dozens of times.

            These techniques are nearly 100% effective, painless and easy to perform, and the patient will feel immediate relief of their pain.

            Pretty cool techniques, and you can find them demonstrated on video in the members area. And no surgery required.