The thoracic outlet is an area between the clavicle and the thoracic cage, located between the shoulder and the neck (Boezaart et al., 2010). Thoracic Outlet Syndrome (TOS) is a disorder characterized by the compression of neurovascular structures as they pass through the thoracic outlet, resulting in multiple diverse symptoms (Boezaart et al., 2010). By far the most common neurovascular structure affected by TOS is the brachial plexus, with 95-98% cases caused by its compression (Boezaart et al., 2010). Other structures affected include the subclavian artery and the subclavian vein (Boezaart et al., 2010). Compression of any of these structures many occur at three separate points in the thoracic outlet: the interscalene triangle, the costoclavicular space and the retropectoralis minor space (Kuhn et al., 2015). There are two different manifestations of TOS, the most common being neurologic, followed by vascular TOS (Kuhn et al., 2015). Neurologic TOS can be characterized by upper plexus or lower plexus compression (Kuhn et al., 2015). Symptoms of upper plexus compression neurologic TOS include upper extremity weakness, numbness, paresthesia and pain in the neck, trapezius, shoulder, arm , chest, head and fingers (Kuhn et al., 2015). Lower plexus compression TOS symptoms include pain in the ulnar forearm and hand, as well as the axillary and anterior shoulder region (Kuhn et al., 2015). Vascular TOS is characterized by venous or arterial clinical subtypes (Kuhn et al., 2015). Venous TOS symptoms include swelling and deep pain in the chest and shoulder (Kuhn et al., 2015). Paget-Schroetter syndrome is a subtype of vascular TOS and is described by thrombosis of the subclavian vein due to repetitive injury, especially in young and healthy adults (Kuhn et al., 2015). The rarest form of TOS is arterial but it is possibly the most devastating, and is cause by the compression of the subclavian artery. This results in symptoms of pain, numbness, coolness and pallor (Kuhn et al., 2015). Long-term compression can lead to aneurysms, thrombosis, embolic events and potentially limb-threatening ischemia (Kuhn et al., 2015). Occupation and Thoracic Outlet Syndrome TOS is often preceded by trauma or repetitive strain (Laulan et al., 2011). Occupations that rely on the use of the upper body pose risk factors for not only injury, but for TOS as well (Laulan et al., 2011). There are many occupations requiring repetitive abductive upper arm movements (Laulan et al., 2011). This, in combination with a heavy load being supported by extended arms, can result in compression and pressure on the brachial plexus, which can result in proximal pain in the upper arms and thus lead to TOS (Laulan et al., 2011). In addition, poor posture can create an imbalance in the peripheral nervous system and in the muscles surrounding the shoulders, and this posture-related TOS may predispose patients to other musculoskeletal disorders (Laulan et al., 2011). Research has proposed that awkward work postures and constant muscle tension are more indicative of TOS symptoms than the actual heaviness of the workload (Sällström & Schmidt, 1984). The prevalence of TOS symptoms in the general population is unknown in …show more content…
However, it only became known to the western world when David Daniel Palmer coined the term and developed a scientific rationale for the practice in 1895 (ACA, 2016). Over the past few decades, the practice has become increasingly commonplace and sought out in domains previously dominated by allopathic medicine (ACA, 2016). Today, chiropractors are licensed in most developed nations including Canada (ACA, 2016). Chiropractic medicine has received plenty of recognition for its effective treatment of spinal pain; predominantly lower back pain, neck pain and mid-back pain (Dagenais et al., 2015). Spinal pain is a common and costly issue for the North American medical systems, however over a quarter of patients with spinal pain sought out a chiropractor in 2014 (Dagenais et al., 2015). Chiropractic medicine has been found to be as effective as allopathic medicine for the treatment of back and neck pain (Dagenais et al., 2015). When compared to allopathic medical physicians, chiropractors report having greater confidence in their ability to work with spinal discomfort (Dagenais et al., 2015). Furthermore, it has been reported that chiropractic medicine is a more cost effective approach to treatment of spinal issues (Dagenais et al.,