T Nation

Help Me With Nerve Impingement


Ive been having this problem for quite a while now.

Basically it started with pain in my shoulder, and i thought it was rotator cuff problems, but then i started to notice the pain in my hand, and bicep as well.

Im pretty sure it is Thoracic outlet syndrome, and is a result of a trigger point on my trapezius, right on top of the medial part of my scapula.

The pain/numbness comes and goes, but i have found that when its "flaring up" if i push on that trigger point and massage it, the pain tends to go away temporarily.

I have seen a physical therapist for this, and he wasn't possative what it was, but just told me to massage that spot anytime it hurt.

He did say it may be a result from poor posture when sitting, but ive been working on that.

Ive been working on posture and flexibility, doing broomstick rotations. Anyone have any experience with this, or what might help with it?


Heres another pic


Good work!

May I suggest:
Xrays including C-spine. You may have a cervical rib only, and not the complete thoracic outlet syndrome, which has a dynamic component. (Loss of pulse on raising the effected arm.)

For your reading enjoyment, a citation from the Ethiopian medical literature:

Ethiop Med J. 2003 Jul;41(3):227-33.Links
Management of cervical ribs causing neurogenic thoracic outlet syndrome: a ten year experience in the neurosurgery unit, Tikur Anbessa Hospital.
Munie T.

Department of Surgery, Tikur Anbessa Hospital, Addis Ababa, Ethiopia.

Eighteen cases of cervical Ribs causing numbness, paraesthesia and wasting of hand muscles were seen during the years 1990 to 1999 in neurosurgery unit of Tikur Anbessa, a central, referral teaching hospital. There were thirteen cases of unilateral, and 5 bilateral brachialgic pains M:F = 1:2 with ages range from 15-50 yrs (mean age 32 +/- 4.8 yrs); though it is 3 times common in women specially those with neurologic symptoms. 5 cases didn't have any cervical ribs. All had respective cervical rib resections and scalenotomy done. Paraesthesia and pain were relieved in about 90% of the cases. Cervical rib causing Thoracic Outlet Syndrome (TOS) is a rare condition commonly seen in less than 1% of the population as seen here in 18 cases in 10 years period. The absence of cervical rib doesn't rule out thoracic outlet syndrome as it can be from anomalous first ribs, scalenus anticus syndrome or congenital fibromuscular bands. Surgical excision has a good neurological outcome. No subclavian vessel especially arterial compression cases were seen in this study as cervical ribs can cause neurovascular compression. The diagnostic and therapeutic measures are clearly stated as this syndrome is a diagnostic and treatment challenge to the practicing general surgeons. Accurate diagnosis and proper surgical intervention are very crucial for the good outcome.


If it's TOS, then welcome to hell. Check some of my old posts for how bad it can be. (I had to drop out of grad school because it hurt too much to write and type) Mine is mostly in check now after 4 YEARS of the worst parasthesia pain disfunction etc. I still can't lift or do my striking heavy or often because of it and have to have weekly massage on my neck and bracial plexus region.
Here are some links to info:






Wow thanks, ive got some reading to do. Luckily its on my right hand and im left handed, so it isn't really interfering with my life that much.

I'll read a lot of that info, and that one site recomends the book about carpal tunnel and TOS, i may get that.

If i have found that trigger point thats causing most of my problem, do i just massage that out as much as i can, or do i also need to do some flexibility / strengthening exercises to improve posture?

thanks once again.


Yeah, you want to hit it with as many different treatments as you can. Definitely work that trigger point as often as possible, do the stretches, look into posture too.