13/03/2025
Assessing and Treating Neurogenic Thoracic Outlet Syndrome
The term double crush syndrome (DCS) was coined by Harvard University plastic surgeons Albert Upton and Alan McComas, who wrote, “Neural function is impaired when compressed axons at one site cause the nerve to become especially susceptible to damage at another site.” Their double crush research began after observing that many carpal, cubital, and radial tunnel patients also complained of unilateral shoulder, chest, and upper back pain. While the DCS mechanism is not completely understood, it likely involves nerve sensitization and neuroplastic changes in the pain-modulating systems of the brain and spinal cord.
Neural compression of the brachial plexus is called neurogenic thoracic outlet syndrome (NTOS). These clients present with a variety of symptoms, including painless atrophy of intrinsic hand muscles and nighttime paresthesia. Athletes may have difficulty grasping a racquet or ball, and some report pain. However, I’ve found that rather than being the main pain event, NTOS is more of an enhancer of symptoms at a distal site, such as the carpal tunnel. Put simply, the brain pays more attention to double crush nerve insults and is more likely to respond with pain or spasm.
Read more in this week’s Technique Tuesday blog post and learn methods to assess and treat NTOS. Visit blog.erikdalton.com and sign up for Technique Tuesday for articles and demonstration videos delivered to your inbox without subscription fees.
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