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L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 37 Compression and subsequent neurovascular compromise at any of these regions within the thoracic outlet is described as thoracic outlet syndrome. Unfortunately, this term does not distinguish which regions or structures are affected. It is not uncommon for multiple regions to be affected and symptoms consistent with neurovascular compression to increase, diminish, or alter with changes in position or activity. Symptoms vary in both quality and severity and include sensations of numbness, tingling, weakness, fullness, heaviness, and fatigue, with notable discoloration or temperature changes in the affected upper extremity. MECHANICS Thoracic outlet syndrome may be caused by a variety of congenital factors, such as skeletal and muscular anomalies. Examples include the size and shape of bony landmarks like the first rib, clavicle, and coracoid process; the pathway the brachial plexus travels through the scalene muscles; and the angle and position of the pectoralis minor tendon. Acquired conditions may contribute to neurovascular compromise through the thoracic outlet. Trauma and resultant healing processes like a fractured clavicle are a common cause of thoracic outlet syndrome. Postural deviations and repetitive stress or movement patterns are also culprits, and are most successfully addressed and prevented using conservative methods like bodywork and movement education. Focus should be placed on identifying shortened soft-tissue structures like the scalene, subclavius, and pectoral muscles while addressing specific issues related to the client's posture and potentially exacerbating movement patterns. Christy Cael is a licensed massage therapist and certified strength and conditioning specialist. Her private practice focuses on injury treatment, biomechanical analysis, craniosacral therapy, and massage for clients with neurological issues. She is the author of Functional Anatomy: Musculoskeletal Anatomy, Kinesiology, and Palpation for Manual Therapists (New York: Jones & Bartlett Learning, 2010; jblearning. com). Contact her at Assessing Scalenes Positioning: client supine. • Locate the cervical transverse processes deep in the lateral neck between the trapezius and sternocleidomastoid muscles. • Follow the slender, somewhat stringy fibers of the scalenes inferiorly to their attachment on the first and second ribs. • Resist as the client laterally flexes their head to the same side to ensure proper location. • Passive lateral flexion to the opposite side will be restricted if the scalenes are shortened or hypertonic. Assessing Pectoralis Minor Positioning: client supine. • Begin with the shoulder slightly abducted and supported. • Slide your fingers into the axilla from lateral to medial along the anterior surface of the ribs. • If necessary, horizontally adduct the shoulder passively to further slack tissue as you palpate with your other hand. • Resist as the client rounds their shoulder forward (scapular depression) to ensure proper location. The proximal shoulder will remain elevated off the table when the client is relaxed in the supine position with arms at their sides if the pectoralis minor is shortened or hypertonic.

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