Everything you need to know about pain and how we can help you

Often just knowing how to correctly release trigger points, stretch the fascia and relax the muscles in the neck and collarbone area is all that is needed to eliminate Thoracic Outlet Syndrome. DMR Therapy® specializes in precisely these procedures.

The thoracic outlet is a narrow passageway from the lower neck to the armpit. It is the space between the collarbone (clavicle) and first rib, and crowded with blood vessels, muscles, and nerves. Thoracic outlet syndrome (TOS) is a disorder that can occur when blood vessels or nerves in this space are compressed. This can cause limited range of motion of the arm and shoulder, a weakened grip, finger numbness and shoulder and neck pain.

There are two types of this syndrome. By far the most common (neurogenic) affects the nerves by compressing the brachial plexus and causes pain and weakness in the shoulder, neck and arm down to the thumb. The other type (vascular) affects the veins or arteries, which may result in swelling, pain or discoloration in the arm or cold hands and fingers.


Repetitive activity such as typing on a computer, working on an assembly line or repeatedly lifting things above one’s head might be the cause. Athletes, such as basketball and volleyball players, weight lifters, baseball pitchers and swimmers are often vulnerable.

Trauma such as whiplash. Also stress, poor posture, tumors, etc.


  • Exercise: Initial treatment might consist of exercises to strengthen chest muscles and stretch shoulder muscles to open the thoracic outlet and improve posture.
  • Medication:
    • anti-inflammatory medications such as ibuprofen (Advil) or naproxen (Aleve)
    • pain medications such as NSAIDs
    • muscle relaxants
  • Surgery is typically done if no improvement is achieved with other treatments. Removal of the first rib might even be indicated, or a scalene muscle in the neck may be removed to relieve compression.


There are four main mechanisms that produce Thoracic Outlet Syndrome and normally all four are involved.

  • Two of the scalene muscles run from the cervical vertebrae of the neck and attach to the first rib. Tension in these muscles can pull the rib toward the clavicle, compressing the nerves and blood vessels. The solution is to relieve the tension in these muscles, NOT to cut them or remove a rib.
  • The pectoralis minor muscle runs from the shoulder blade to the third, fourth and fifth rib in the upper chest. When this muscle is tight it also can compress these nerves and blood vessels. Again, the simple solution is to release the tension in this muscle.
  • The third factor is the fascia, the tough, strong tissue which encases this whole area and envelopes the muscles, nerves and blood vessels. When unhealthy, this connective sheath can strangle these soft tissues and impede their function. Stretching this fascia opens this outlet and releases the encased muscles.
  • Trigger points are nearly always involved. Not only are they a factor in over-tensing the muscles, but the trigger point patterns in both the scalenes and pec minor can identically mimic the symptoms of Thoracic Outlet Syndrome. In many cases, TOS is simply a misdiagnosis of trigger point referral from these muscles into the shoulder and neck and down the arm.

DMR Therapy® specializes in precisely these procedures. Knowing how to correctly release trigger points, stretch the fascia and relax the muscles is normally all that is needed to eliminate Thoracic Outlet Syndrome. An additional benefit is that there is no “recovery” period from invasive procedures or the effects of drugs.

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