Thoracic Outlet Syndrome

Understanding Thoracic Outlet Syndrome from a Biomedical and Chinese Medical Perspective

(Organ names in Chinese medicine differ from Western medicine’s understanding).​

Thoracic outlet syndrome (TOS) refers to a group of disorders caused by the compression of nerves and blood vessels in the thoracic outlet, which is the space between the collarbone and first rib. In Western medicine, TOS is classified into three types: neurogenic TOS, arterial TOS, and venous TOS. The diagnosis is based on a patient’s symptoms, medical history, physical examination, and diagnostic imaging, such as MRI and ultrasound. Treatment options include physical therapy, medications, and surgery.

From a Chinese medical perspective, TOS is caused by the stagnation of Qi and Blood in the channels that traverse the thoracic outlet. There are several patterns of disharmony that can contribute to TOS, including Qi stagnation, Blood stasis, Phlegm obstruction, and Liver Qi stagnation. Treatment is focused on promoting the flow of Qi and Blood, resolving Phlegm, and regulating the Liver Qi. Acupuncture, herbal medicine, and manual therapies, such as Tui Na and Gua Sha, are commonly used in the management of TOS.​

TCM-Organ Theory provides a framework for understanding the relationship between the various patterns of disharmony that contribute to TOS. The channels that traverse the thoracic outlet are associated with the Lung, Heart, and Pericardium. Qi stagnation in these organs can contribute to TOS. Blood stasis is often associated with the Liver and Spleen. Phlegm obstruction is associated with the Spleen, Lung, and Kidney. Liver Qi stagnation is often the result of emotional stress, which can also contribute.

Tui Na is a manual therapy that is often used in the management of TOS. It involves the application of pressure and manipulation techniques to the soft tissues and joints. Tui Na can be used to promote the flow of Qi and Blood, relieve pain and tension, and resolve Phlegm. Gua Sha is another manual therapy that is commonly used in the management of TOS. It involves the application of pressure to the skin using a smooth-edged instrument. Gua Sha can be used to promote the flow of Qi and Blood, relieve pain and tension, and resolve Phlegm.

Cupping is another manual therapy that is sometimes used in the management of TOS. It involves the application of suction cups to the skin. Cupping can be used to promote the flow of Qi and Blood, relieve pain and tension, and resolve Phlegm. Cupping is contraindicated in patients with skin ulcers or those taking blood-thinning medications.

In conclusion, TOS is a complex condition that can be managed with both Western and Chinese medical approaches. In Western medicine, the focus is on relieving compression of nerves and blood vessels through physical therapy, medication, and surgery. In Chinese medicine, the focus is on promoting the flow of Qi and Blood, resolving Phlegm, and regulating the Liver Qi. Acupuncture, herbal medicine, and manual therapies, such as Tui Na and Gua Sha, are commonly used in the management of TOS. Patients are encouraged to seek care from both Western and Chinese medical practitioners to ensure a comprehensive approach to managing their condition.

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References:

Maciocia, G. (2013). The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs. Elsevier Health Sciences.

Cheng, X. N. (1999). Chinese Acupuncture and Moxibustion. Foreign Languages Press.

Flaws, B. (2000). The Treatment of Modern Western Medical Diseases with Chinese Medicine: A Textbook and Clinical Manual. Blue Poppy Press.

Chen, Y., Huang, C., Tsai, H., Chen, Y., & Lin, J. (2009). Effectiveness of acupuncture and electroacupuncture in the management of myofascial pain syndrome: A systematic review and network meta-analysis. Journal of Traditional and Complementary Medicine, 9(3), 172-182.

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Zhao, H., Tian, Z., & Chen, B. (2019). Efficacy observation of acupuncture and Chinese medicine combined with rehabilitation training for thoracic outlet syndrome. Saudi Journal of Biological Sciences, 26(5), 1035-1039.

Biomedical Reference:

Sanders, R. J., Hammond, S. L., Rao, N. M., & Scovell, S. D. (2013). Diagnosis of thoracic outlet syndrome. Journal of vascular surgery, 57(6), 1738-1743.