Thoracic Outlet Syndrome and Hypermobility

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Why are EDSers prone to Thoracic Outlet Syndrome?
There are many causes of Thoracic Outlet syndrome (TOS). TOS is caused by a combination of anatomical differences and muscle imbalance. TOS is a common comorbidity with disorders involving hypermobility. When the hypermobility is a result of joint instability  like EDS, muscle imbalances are often the cause of TOS.

How to approach TOS for the EDS population:
The best way to treat this type of TOS is to correct the muscle imbalance. The brachial plexus runs through the muscles of the neck and upper chest. The brachial plexus can become impinged if these muscles become over active and hypertrophied. These muscles can become overactive to try and compensate for instability of the shoulder, neck, and scapula. In people with hypermobility, TOS is usually accompanied by rounded shoulders and an imbalance called upper crossed syndrome.

UCS

Here’s a link to some more information on Upper Crossed Syndrome including a short yoga routine you can start your day with. Yoga For Upper Crossed Syndrome

So, although the symptoms of TOS may be in the arm or hands, the root of the problem usually begins in the scapula. The scapular joint is inherently unstable and causes many problems for EDSers. When the mid and low back muscles aren’t strong enough to prevent scapular winging and protraction, the upper chest muscles will inappropriately act to help live the arm. Over time the scapula get weaker and the upper chest muscles get stronger. This creates rounded shoulders, compression off the brachial plexus, and instability at the glenohumoral joint. However, trying to strengthen the glenohumoral joint when the scapula is relativlaly pointless and will likly result in more pain and problems than benifits. It’s important to address these problems in a logical order and not all at one time.

When I was starting to uncover these problems my joints were so unstable and my muscle balance was so extreme, that I don’t think I ever would have made any progress if it weren’t for the help of one of the top TOS clinics in the country. Luckilly I happened to live down the street from this hospital, but I know that lots of people travel to this clinic for treatment, therapy, or surgery if needed. With EDS, surgery is very much a last resort treatment. Luckilaly there is an inbetween treatment option that involves temporarily inactiving the overactive upper chest or neck muscles by using botox injections. Here’s the link to their website for more information: Washington University STL TOS Clinic

Hopefully, you are getting help early enough that a good exercise program and modifiing  your daily routine will be able to stop the TOS from worsenning and eventually you can begin to recover.

Strengthening The Scapula

Here are the exercises I’ve used to strengthen my scapula. They are in order of how I progressed through them. It’s taken me several years of  regularly doing the first four before I could attempt the last few, so please don’t start them all at once. I recommend doing one or two of the early ones at least a few months before trying to move on. Also, by move on, I don’t mean for you to stop doing the earlier ones. At least for me I know I have to keep doing all of them to prevent regression.

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What about the shoulder joint?

Instability of the glenohumoral joint contributes to the irritation and compression of the brachial plexus, especially if you are dislocating partially or fully on a regular basis. However, I don’t think there is any point in aggravating yourself with any PT for the shoulder until the scapula is able to function correctly. The best thing you can do in the meantime, is focus on resting the arm in neutral positions. I found that most of my nerve irritation was caused by sleeping on partially dislocated shoulders. The best position I’ve found to prevent this problem is sleeping on my back. I also put a pillow under each of my arms to keep the glenohumoral joint in alignment.

What if I don’t have the patience for physical therapy?

The most important thing to consider in your exercise routine is finding something that you can actually commit to doing. I always try and eliminate the tedious boring exercises as much as possible.  There’s only so much I can tolerate before I just want to give up. Try and find something that works with your natural movement patterns and requires less cognitive input. I’ve had success treating my TOS with rock climbing and swimming breast stroke. Recently, I’ve also started experimenting with rowing, but I believe that rowing could definitely cause more problems for TOS if it’s not done in correct form. If I were you, I would start with swimming breast stroke.

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