- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Brad, today we're gonna talk about top three signs
that you might have thoracic outlet syndrome.
Which, by the way, this is very interesting this week,
one of our employees actually started complaining
of some pain down here, up through here, down into the arm.
- Yeah.
- We determined it was thoracic outlet syndrome.
We actually treated it and made it better quite easily.
- So the symptom of thoracic outlet syndrome
- Well, first off it's usually caused,
let's talk about what it is real quickly.
You have nerves, arteries and veins that are coming from
around by the lower neck, upper thoracic area.
The brachial plexus is basically what it is.
We're trying to represent it
with this red Thera tubing here.
That's kinda the path of the nerve, artery and vein
as they go through.
The come through and they go up over the rib
and they go down underneath the clavicle or the collar bone
and then they go down here and they go into the arm.
- It's quite a squeeze in here.
- It is, there's a lot of muscles.
That's the whole thing, it tends to get pinched up here,
basically.
There's a couple areas.
One, there's two muscles right here in the neck,
anterior and middle scalenes, it could pinch there.
There the peck minor, pectoralis minor,
one of the chest muscles, it could pinch there.
If you have an extra rib, which some people do.
Some people have what is called a cervical rib,
that means a rib that's actually coming off their neck.
It attaches with cartilage to the other rib,
it can put some pressure on the nerve, artery and vein too.
These are, quite often the cause can be a cervical rib.
In Alex's case, hope it's okay I said his name?
- Oh, sure.
- In Alex's case, he tends to do a lot of weight lifting
and he wants to work on his chest and become big
and attractive to the women.
What happens is he doesn't work on his back at all.
- Right.
- When you get pulled down like this,
that actually can increase the stress
on the nerve, artery and vein through there.
Now, generally in 95% of the cases
of thoracic outlet syndrome the pressure is on the nerves.
In 4% it's the veins and only 1% is at the artery.
You're generally gonna have more indicators
that are indicating that it's a nerve problem.
What are some of the things that you're gonna feel, Brad?
- That's a good question.
It's down the arm typically because the nerve is
usually getting pinched up here, so numbness,
tingling, might be some burning.
- Right, and the little finger and the ring finger,
it tends to be quite common, must be that ulnar nerve.
- Right.
You could get pain even up in the back and some of the neck,
but generally the cases I see, there's not as much up there,
it's more down in here.
That's what alerts me to the fact that it might be
thoracic outlet syndrome,
you're getting all this stuff down here.
- Typically a lot of people that work overhead
with their arms, mechanics, people working on drywall,
ceilings, those are common.
- Anything that's gonna close this area off.
- Right.
- The other thing is, if the artery is involved, by the way,
or the vein, you might be getting some changes,
like it'll feel cold.
The type of things like circulation issues.
The arm might feel weak.
- How do we test for this?
- Let's show the test.
Let's get him outta they way, we don't need him right now.
- Whoa.
- The first one's a real simple test
that you can do on your own.
This is called Roos Test, R-O-O-S.
What you do is 90, 90, basically.
90 degrees here, 90 degrees here, right angle, right angle.
Now this, the little controversy on how many times
you're supposed to do this, when I looked up in one of our
text books they said 15 times, where you're gonna squeeze
your hand, open, squeeze your hand like this.
What you're looking for is a reproduction of the symptoms.
Let's say you're down and you're fine,
you the have any symptoms.
You do this 15 times and all of a sudden you're starting to
get numbness and tingling pain down the arm.
Now, I've seen other places that have said though,
that you should do this for three minutes.
I've seen another place that said you hold it for a minute
and then you do it for two minutes.
Just a lot of variations.
I've seen where you do it for a minute and a half.
Basically da, da, da, da, da, da, da.
- The chicken trot.
- The chicken dance.
You're gonna start the start of that.
Usually I'd do that at a dance.
- That'll reproduce the symptoms and then if that's it,
that's a possibility.
- That's a possibility you might have
thoracic outlet syndrome.
- Doesn't mean you definitely have it.
- The other one, you're gonna need someone to help you.
You're gonna need someone that can take a pulse.
Now, to take a pulse, basically the artery is right below
the thumb here and you're gonna go ahead and put a couple
fingers on there and I can feel Brad's pulse right now.
You're gonna take his pulse, you're gonna feel it
and with him standing here I'm gonna take the arm up
30 degrees which is just a slight abduction.
I'm gonna extend it, I still feel his pulse.
Now Brad's gonna bring his neck back like this.
Then turn toward me, now I have him take a deep breath.
(breaths deeply)
Good, he holds is and there was no difference at all.
The pulse was exactly the same.
When I did this on the person that works for us,
it actually stopped for a minute.
- You could feel it?
- I could feel the pulse stop.
There's also reverse Adson's where you go back
and then turn the other way and then take a deep breath.
(breaths deeply)
Same thing, Brad, you got a good,
healthy pulse no matter what.
- Okay.
- Now, as one final test that you might wanna do,
if you wanna try to rule out maybe it's really coming
from the neck itself.
Maybe from one of the little holes
where the nerves come out,
you can have the person extend and turn towards me
and then I push down through his head and if that reproduces
the pain going down, then it maybe is more of a neck problem
and not so much the thoracic outlet syndrome.
So just a couple tests you can do.
You can maybe direct your doctor then when you say,
this stuff is positive
and do I have thoracic outlet syndrome?
- Don't push too hard on the neck, that's a gentle push.
- Yeah, gentle push.
We're not, you know, you idiot.
That's it.
Now we're gonna show top three stretches
for thoracic outlet syndrome in the next video,
I'll link it up right here.
If you haven't already, make sure you subscribe
because if you don't, Brad's gonna come out and find you
and make you subscribe because he's strong like bull.
All right.
- Take care.
(slaps hand)