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News You Can Use (Thoracic Outlet Syndrome) April 30, 2011

Posted by FCM in health, news you can use, thats random.
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awhile back, i posted about food sensitivities and i find that i keep referring to it myself, to see what foods are on the list.  i found it useful, in real life.  at the time, i didnt know whether “news you can use” would become a series, or if it was just a one-time thing.  so…series it is!*

i have had reason of late to do some learnin’ about thoracic outlet syndrome.  dont ask.  it can be quite serious, and can cause anything from varying degrees of pain and neurological symptoms, to deep-vein thrombosis (DVT) which can kill you, or cause you to lose an arm.  yay!  apparently, its caused by “pressure on the nerves or blood vessels as they go through the thoracic outlet,” and causes a cluster of symptoms that may include some or all of these, in the neck, upper back and arm, and usually on just one side of the body: coldness in the upper arm or chest, fatigue, numbness, pain, swelling, tingling, and weakness.

heres some anatomy!  from the link:

Between the rib cage and the collarbone (clavicle) is a space where the main blood vessels and nerves pass from the neck and the chest into the arm. This space is called the thoracic outlet. From this outlet, the nerves and blood vessels leave the neck between two muscles (scalene muscles).

theres important stuff in there!  and from what i can gather, thoracic outlet syndrome is normally due to either neck trauma, or from repetitive use of the arm.  and more women get it than men.  hmm!  while the evolutionary biologists (and fat theorists–apparently “obesity” is also a risk factor) are wanking over that one, heres a few more pictures i thought were relevant (remember, this is caused by pressure on the nerves and blood vessels between the neck and the shoulder):

interesting right?  the scholarly article in the first link mentions extremely briefly that “large breasts” and “heavy backpacks” can rarely (read: are known to sometimes) cause this excruciating and dangerous neurovascular disorder, and the second article mentions that a behavior modification you can adopt to treat it, after you already have it, is to wear a strapless bra.  interesting, again!

reading various articles about it online also reveals that this is very commonly misdiagnosed, because the symptoms are vague and are similar to a number of other conditions like herniated cervical discs, with radiating pain down the arm.  heres what i would like to suggest, in general, if you are able: if you have any kind of an injury at all, or anything to do with a shoulder or a knee in particular, go to an orthopedist that specializes in sports injuries.  just do it.  my mom (a nurse who was married to a doctor for 15 looong years) told me a long time ago that doctors that specialize in sports medicine are completely different than regular docs who treat “sick people”: sports medicine docs treat healthy, active people who have hurt themselves, by being active.  for some reason, the mentality around this is completely different, for the doctor.  different than say general practitioners, or those who deal with degenerative or congenital defects, or health problems related to aging.  apparently, theres a difference between treating sick people and injured people, or perhaps a different kind of person is drawn to treating one kind of patient over another?  i dont know, but docs who treat injured, yet healthy and active people for a living seem to take their patients more seriously, and listen more closely to their patients histories, and complaints.  i am not saying this is good, or right, or fair, or anything.  all i am saying is this is probably news you can use.

and for trauma and repetitive-trauma to shoulders and knees, sports medicine specialists have just about seen it all.  the doc i saw diagnosed me within a few minutes, saying that i had one of the most textbook-cases of thoracic outlet syndrome he had ever seen.  and instead of being misdiagnosed for years, as frequently happens, i am getting treated, now, and its reversible, if you catch it in time.

i hope this is helpful to someone!  oh, and you all know that women have more foot problems than men too right, and that its because of womens shoes?  okay good.  that is all.

*i would like to dedicate this series to my mother, who told me, very helpfully, when i was four years old: “if you are sick with diarrhea and you feel like you have to fart, go to the bathroom.”  largely thanks to her, and that one piece of sage advice, i havent crapped my pants since i was 4.  and i know for a fact that there are many, many people who cant say that.  so, thanks mom!


1. Mandy - April 30, 2011

[I am a regular, almost daily lurker on practically every radfem blog out there, and while I will probably remain in lurker-dom for the time being due to work hours, I decided to “share the wealth” a little here as it’s close to the area I work in. Hopefully it’s worthwhile to someone out there. Keep up the great work, everyone! You have all helped more women than you can imagine.]

It’s interesting to note how the treatment for thoracic outlet syndrom (TOS) involves several activites that women aren’t usually encouraged to do: *balanced* upper body strengthening and proper breathing techniques, i.e. breathing using your “stomach” muscles so that your abdomen rises with each breath. Women have been noted to breathe using their scalenes (basically moving your clavicle up and down to breathe), with the reasoning that doing so prevents them from looking like they have a “gut” -or- because their tight-fitting clothing at the waist all but requires it. This type of breathing causes an overdevelopment of parts of the musculature that runs through the brachial plexus (another name for TOS is brachial plexopathy), which can lead to the inflammation and symptoms you already described. When combined with underdeveloped shoulder/scapular musculature (encouraged in women of course!), this would create a perfect enviroment for TOS.

Poor posture is also a risk factor for TOS, and while I can’t recall any sources pointing to the use of high heels in the development of the type of posture that can lead to TOS, I wouldn’t be at all surprised if there is a relationship. What affects the alignment of one part of your body will affect the alignment of most, if not all, parts of your body.

Another point I wanted to add about proper breathing techniques: you do want to try to breathe using your “stomach” muscles (really your diaphragm here). Diaphragmatic breathing allows you to inhale more deeply, which improves oxygen flow to all parts of your body. Fatigue and anxiety are just two issues that can be partially helped by using proper breathing techniques – and isn’t it interesting that these two issues are usually associated with women?

2. FAB Libber - April 30, 2011

Interesting info on the doctor mindsets.
In general, doctors don’t take womens’ pain/symptoms seriously, misdiagnosis (or no diagnosis) happens often.


3. FAB Libber - April 30, 2011

Excellent point about the tight-fitting clothing Mandy. And I would think high heels do contribute to poor spine alignment, it is a very unnatural way of walking, apart from the obvious calf muscle damage.

FCM - April 30, 2011

thanks for that mandy. i didnt know what lies ahead as far as treatment goes, for now i am using anti-inflammatory patches on the area and am scheduled for an MRI. i am paying attention to whether i breathe using my clavicles or not…and i can honestly say i have never thought about that before!

i *also* wanted to mention that this post is very different than the ones i usually write…everything about it is different, including how the words feel on the page. this is foreground stuff, yes?


4. zeph - April 30, 2011

Very informative post.

5. KatieS - April 30, 2011

I’ve been taking Pilates classes and it has improved my posture, after even one session I noticed it and felt better. I started it after having physical therapy for a torn knee. I tried a number of different teachers and found one I like, they vary in approach quite a bit. I wonder if it would help with this condition.

Also, I enjoyed the previous post on food sensitivities. I have gluten sensitivity, and one thing that often goes along with it is called “oral allergy syndrome” or OAS. Having OAS means that you will be sensitive or allergic to one or more foods by groups. Tingling of mouth and lips after eating certain foods are a sign you have this but other symptoms occur, too. Wikipedia has a pretty good entry on it if anyone is interested.

Also, I ate almost exclusively nightshades for about a month (wheat my garden had at the time) and developed HORRIBLE joint pain and a nodule on my finger that looks like rheumatoid arthritis. The pain comes on if I eat many nightshades at the same time. It stops if I stop eating them. Nightshades include tomatoes, white potatoes (not yams or sweet), eggplant, peppers. The nightshade reaction is not part of the oral allergy syndrome.

I didn’t mean to highjack the current post, but thought this might be useful information. The current post reminds me that I should not be carrying a heavy shoulder bag with books, etc. in it. I do this daily.

Also, if women get it more than men is osteoporosis implicated? That deterioration of the bones cannot be good for this area.

6. thebewilderness - April 30, 2011

Did you see this FCM?
I’m having a sad.

FCM - April 30, 2011

i hadnt seen that TBW. i finished reading “how to supress womens writing” a couple of weeks ago, and just havent gotten around to posting about it. the thing i remember the most was where she described what writing classes were like for her, as a student, where she was writing whatever she was writing about and getting only mediocre responses, while the doodbros in the class were writing about “fucking whores and puking in the gutter” and getting the highest praise. it really made it all to clear for me, not only what female WRITERS are up against, but what it means to put the pen-to-paper when your SUBJECT MATTER is 100% female-identified radical feminism. its really profound what we are battling here, on every level. thanks for the link.

FCM - May 1, 2011

heres another graphic, about the bathroom dilemma that UP is discussing over at her place:


FCM - May 1, 2011

katie, from what i can tell, the pressure on the nerves and artery/vessels in this area is from soft tissue (not bones) that entrap the nerves etc. some people are born with an extra rib which can cause it but i dont know how they wouldnt know this early on; some kind of soft tissue entrapment must come into play for them as well? overdevelopment of some muscles and underdevelopment of others, as well as inflammation call come into play to cause the soft tissues to partially close the space thats needed for the nerves/vessels to function properly. the “space” is partially created by bone, but i dont think its the bone that causes it for most people, or they would have problems early.

as far as i can tell, inflammation is definitely implicated here, and food allergies and sensitivities play a huge part in systemic inflammation so YES, i believe this is all relevant, and connected.

FCM - May 1, 2011

and yes, i think its a terrible idea to carry any more than what you absolutely need…lighten those bags ladies! seriously. we carry around so much shit, and the bigger the bag, the more unnecessary shit finds its way in. unclutter and lighten up, if you can. thats free advice! now about those bras…

7. delphyne - May 1, 2011

Oh take the bras off. My ribcage/chest has expanded literally two inches since I stopped wearing one regularly. Whose idea was it for women to have a big band of elastic around their lungs? Yet another example of women being treated as if we aren’t living breathing creatures, but rather showroom dummies.

Thanks for this post FCM, I’ve been getting a lot of problems with my arms and shoulders (pins and needles), I’m thinking this might point to the source of the problem.

FCM - May 1, 2011

youre welcome delphyne! i am glad this was helpful, its what i was going for.

8. Sargassosea - May 1, 2011

When I was a junior in high school one of the kids’ desk fell apart and there was much ado about what we should do (no extra desks or even a chair). So I get my bag and whip out a crescent wrench and fix the desk; didn’t need the screwdriver though.

It was then that I realized that my bag was totally out of control! Sure, I needed the tools because my p.o.s. car was always breaking down but I didn’t really need them in my purse. I went cold turkey the next day and started carrying everything on my person including my tampons, proudly toted in my shirt pocket. In reality purses are really for hiding away *our* menstrual supplies and makeup.

Also, I just flashed on those damn baby-tote sling things. I had one of those and used it exactly once because it felt like it was cutting off circulation to my BRAIN, ffs. Oooo, and I just love (hate) the way that these *ethnic* slings are marketed to White Women as *natural* because brown people use them! Blech.

FCM - May 1, 2011

I went cold turkey the next day and started carrying everything on my person including my tampons, proudly toted in my shirt pocket.

HA! “out” tampons. love! i once read a “horror story” about a woman who was going through her purse looking for a pen, and she was talking to someone at the time and not really paying attention to what she was doing…well she whipped out a tampon without knowing it, thinking it was a pen, and starts gesticulating with it! she didnt know it was a tampon until she tried to write with it. hilarious right? well…she was mortified of course, but i am sorry, thats just funny. if anyone was offended, they can just go ahead n die.

9. yttik - May 1, 2011

“..it felt like it was cutting off circulation to my BRAIN..”

Ha! That is precisely what it feels like and according to the diagrams above, exactly what is really happening.

Those two scalene muscles in your shoulder are also where many women store a lot of stress. If those muscles are clenched with tension a lot, that would compress the whole area, too.

10. Sargasso Sea - May 1, 2011

Scandle ensued over my tampon toting 😛

Luckily, I never really gave a shit what *people thought of me*! (sorry mom)

11. KatieS - May 1, 2011

The story about the tampon was hilarious!

Though I don’t wear or carry makeup, I do seem to need a lot of the stuff I carry, including medications. In order to do that I need more and decent pockets. This is another way that women’s clothes are poorly designed. Pockets interfere with men being able to see the outlines of our bodies more clearly when we are wearing clothes. So, we get pants with no pockets or just tiny ones. Damn!

FCM - May 1, 2011

someone found this blog by searching “thoracic outlet syndrome.” i am sure this isnt what they had in mind…but i hope they find something here worthwhile! can you imagine? 😛

12. cherryblossomlife - May 2, 2011

I love it when people get to my blog by mistake. Since I put my post up analyzing the fairy tale “Snow White and Rose Red” I’ve had a lot of people who were hoping to find porn ending up on my site. “Snow white porn” etc. Ha! ZING! Have a radical feminist analysis instead, loser 🙂

. I’ve been going out and about without a handbag for quite a few months now. I’ve found that it’s difficult to re-create your body language, especially in uncomfortable situations. I made a point of not taking my handbag to my new job, for example, and my hands were sort of waving about like spare limbs. It’s going to take some practice to look natural and comfortable without a handbag as a prop.
I LOVED the story about the crescent wrench, Sargasso!!

13. TheFrenesi - May 8, 2011

I’m an RN and stumbled on your site after googling TOC. I love your mom’s guidance about going to the bathroom if you have to fart! Nurse + Mom = Priceless Anecdotes

You have the best graphic for TOC anatomy–well done. Fingers crossed I’ll be HEARD by the neurologist next week, I’m miserable and have been bounced around from doctor to doctor. It’s hard being my own advocate. I often wonder if it’s because I’m a nurse, an educated woman or a patient diagnosed with an auto-immune disease (Lupus) that primarily effects the female gender…there’s a definite bias when a woman reports pain and truly taboo if you are depressed about the pain. As an ER nurse, I have seen clinicians assume a patient is drug seeking/depressed/anxious if they have a condition that causes chronic pain. It’s soul sucking to have doctors not listen. I hope I’m making my point??? I think I’m trying to say I just recognized I’m on the receiving end of gender bias. What a happy coincidence I found your blog…I feel more empowered than when I started googling 30 minutes ago. Thanks, I come back again, it was a refreshing experience.

FCM - May 8, 2011

hello, and welcome! if you think you have TOC, you really might want to see a sports medicine doc. seriously. if its TOC you might need an MRI of the brachial plexus to make sure there are no tumors causing the pressure on the nerves/artery…and assuming its not either that or scar tissue/extra rib etc, you might be able to put an NSAID patch over the outlet and some PT. it could be reversed.

i think docs do take you more seriously if you turn them down when they ask if you want narcotic pain relievers! tell them you cant afford to be drunk, you have to work/drive/study whatever. they might suggest something else.

14. linda - May 9, 2011

found these comments helpful and some very amusing.
I personally have suffered pain almost all my life, and constantly found most G.P.’s very unhelpful, everything from watching my weight,and the age process, lack of exercise has been mentioned since I was about 5 or 6 years old. I was a active child running, swimming, cycling, all school sports and exercise classes plus I ran and trained a dog all obedience lessons. Since have worked a full time physical job and had two children, never been able to wear ridiculous heels or have large bosoms, but it took over 30 years to get diagnosis to find out I have cervical and thorasic scoliosis, spondylosis, fibromyalgia and TOC, since finally diagnosed with benign brain tumour so lucky not to of gone blind whilst waiting to be taken seriously as to how much pain I have on a daily basis. I would like to get all of the male G.P.’s I’ve ever had in one room and kick thier stupid, arrogant, asses. I’m almost 50 now and classed as disabled, can’t walk a few yards without severe pain using elbow crutches !!!

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