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Prolotherapy:
Thoracic Outlet Symptoms
JoAnn came to Caring Medical and Rehabilitation Services (Caring
Medical) with a big stack of medical records. The most common diagnosis
she carried from all of the doctors she saw was
Thoracic Outlet Syndrome. JoAnn
exhibited some of the classic symptoms including pain in the arm, neck,
and shoulder. She had a tired feeling in her arm, especially doing
overhead work. She experienced some numbness in the ring and little
finger that would come and go. One of her doctors presented her with the
surgery option. She was looking for an alternative!
On initial physical examination in our office, her muscle strength and
sensation in the left upper extremity were fine. She presented with
classic tender points in the neck, left shoulder, and left medial elbow.
I showed her the
Hackett-Hemwall-Hauser referral drawings which show how
ligaments in the neck refer pain to the head, hands, and fingers. (See
Figure 1.)
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Figure 1: Hackett-Hemwall-Hauser
Ligament Referral Patterns in the head and neck.
By treating these areas with
Prolotherapy, we thought we could
help her get rid of her pain. Just treating the neck, in my opinion,
would produce positive results, though I recommended we treat the neck,
shoulder, and elbow.
As many first time patients are, JoAnn was nervous about receiving
Prolotherapy, so she decided to start with having her
neck
treated. When she returned four weeks later for her follow-up
appointment, she reported that the neck treatment helped with 10% of her
pain complaints. We treated all of the areas on her second visit. This
made a major difference in the numbness she was experiencing. Overall
she needed a total of seven visits. She is back to full activities and
grateful that she can weight lift and do her aerobic classes again.
Thoracic Outlet Syndrome is actual very rare. It is a condition whereby
the space at the base of the neck and shoulder (thoracic outlet) is
narrowed. This encroaches on blood vessels and nerves. Classically it is
caused by an extra rib (cervical rib). The condition does exist
but it is quite rare. Most of the patients we see at Caring Medical have
thoracic outlet “symptoms,” but actually have injury to
ligaments and tendons
that are causing the localized and referred pain, not the actual
syndrome.
Let’s look at JoAnn’s case. Ligaments at the base of the neck can refer
pain into the shoulder, down the arm, and into the fingers. Ligament
injury and
rotator cuff tendon injury can
also produce pain that may refer to other areas when you perform
overhead activities. The numbness in the ring and little finger can come
from ligaments in the base of the neck or the
ulnar collateral ligament
in the elbow. JoAnn received Prolotherapy to all of these structures
with subsequent abatement of her symptoms.
The take home message here is if you or a loved one has been diagnosed
with Thoracic Outlet Syndrome and you would like some treatment options,
visit an experienced Prolotherapist. Prolotherapy is a great alternative
treatment for Thoracic Outlet symptoms!
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