Join Dr. Scott Werden for a free, online and in depth discussion regarding the motion of the arm and the TOS diagnosis.

Dr. Werden is a nationally known thought leader regarding TOS and has been assisting patients for over 20 years to understand the disease. He encourages patients to develop a strong understanding of the disease so that they can partner closely with their physicians to develop better pathways for wellness.


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i'll go through the presentation about arm motion and tos and i'll come back live like this and we'll welcome any questions or comments

arm motion and thoracic outlet syndrome

we're going to discuss and review the anatomy of the thoracic outlet for those of you who have seen some of my previous talks the anatomy section will be a review but for people who are viewing for the first time this will be an introduction without too much detail should be easy to follow for nonmedical people next we'll discuss how arm motion affects the thoracic outlet and finally we'll discuss how these changes in arm motion cause tos it's very important to know this material tos is a form of an entrapment neuropathy we get these all over the body carpal tunnel syndrome for one you've probably heard of but the thoracic outlet and tos are unique because this arm motion creates a really complex extra factor that doesn't just entrap the nerve but can do it in many different ways depending on the person their anatomy their musculature etc

first let's go over some of the key points of the anatomy of the thoracic outlet so what is the thoracic outlet well we've got the natural intrinsic structures of the thoracic outlet we'll take a look at these with some graphics they include the side of the cervical spine the top of the chest the beginning of the shoulder the rib the collarbone the traversing structures are the structures such as the brachial plexus a big nerve bundle the subclavian artery the artery that provides almost all the blood flow to the arm and the subclavian vein the vein that drains almost all of the blood flow from the arm when these structures cross the thoracic outlet they can be affected and when they are affected and they result in symptoms you get thoracic outlet syndrome we also have a series of at least three tunnels as they're classically described by doctors and you've probably heard of these the scalene triangle is one these tunnels are a result of the anatomy of the thoracic outlet and they change in different patients and with different arm positions finally we'll talk about the dynamic changes or the arm motion that's the key point of this talk so the intrinsic structures of the thoracic outlet would be bones muscles lung and other soft tissues such as ligaments here are the basic bony structures we need to know the cervical spine or the neck the first rib at the top of the rib cage which has 12 ribs on each side the clavicle or collar bone as it's commonly called and the scapula or shoulder blade we'll talk in particular about the collarbone the clavicle and the shoulder blade the scapula don't be confused by these medical terms i'll try to use the regular plain english terms i learned as a kid make it easy for all of us let's start out by looking at some of the muscles once the nerves leave the thoracic spine once the artery and vein leave the chest they enter the thoracic outlet and they pass between a series of muscles the most important muscle is the anterior scalene muscle shown here we're not going to discuss the anterior scalene muscle in any great detail for today's talk but you'll be able to see a picture with the anterior scalene muscle and the middle scaling muscle and these two muscles define the scalene triangle there's the anterior scalene in front and the middle scaling in back and between them we get this space which will outline in purple here and that is the scalene triangle you notice that won't change much with neck position or arm motion it's pretty tight and pretty fixed but once the nerves and the blood vessels pass through the space they're going to enter the next tunnel which is a bony tunnel that's called the costoclavicular interval don't worry about the name it's not important but what is important is that you can see the first rib and the bone and between those two bones is a bony space that's the second tunnel that the nerves and blood vessels have to go through remember the pathway of these nerves and blood vessels is to either leave the neck and chest and go to the arm or return from the arm and get to the neck and chest so anything that strucks them or presses on them