Arterial thoracic outlet syndrome can cause the following symptoms: blood clots swelling or redness of the arm hands or arms that feel cool to the touch heaviness of the arm numbness or loss of. This is, clearly, because they still compress the brachial plexus toward the residual 1st costal stump. The onset of paroxysmal AF often may be preceded by evidence of increased vagal tone, especially in patients with lone AF who otherwise have structurally normal heart (29). It is proposed that CPK values become elevated by ischemic or neurologic compromise of muscles supplied by the subclavian artery or brachial plexus respectively. Interestingly after spending a few months trying really hard to improve my posture is when the blood clot formed. This period of exacerbation of symptoms can last all from 2 weeks to 6 months depending on the severity of the situation, and presuming everything is performed correctly (exercises, posture, breathing, etc), and this may of course become a difficult period for the client. My apologies, I dont have the capacity for free back and forths on email. The reason why the potential symptoms are all over the spectrum, is because it in addition to compression of the entire brachial plexus nerve network which innervates the arms as well as parts of the chest, neck and back, also may compress the subclavian artery & vein. They have minimal work capacity, which is why they severely tighten and irritate the surrounding nervous structures. So I was thinking that I might not need my first rib removed. This is almost always caused by tightness of the SCM and scalenes, and/or depression of the clavicle (we now know that these two often go hand in hand), as it compresses the subclavian artery and thus compromises these structures. Coronavirus (COVID-19): Latest Updates | Visitation PoliciesVisitation PoliciesVisitation PoliciesVisitation PoliciesVisitation Policies | COVID-19 Testing | Vaccine InformationVaccine InformationVaccine Information. Signs of neurogenic TOS are as follows: Pain or aches in your neck, back of the head or shoulder. Probably a combination of all three. Is there a difference in treatment if it was brought about by an injury or if it was just developed over time? Also I broke my neck about 6 years ago so Im sure thats where the problem is from as well as bad posture. stick to your guns and look for a doctor familiar with TOS. The moral of the story is that if it looks really bad, it probably is, and it may be well worth going easy the first weeks. Ferri FF. Therefore, this study suggests that SEPs are not helpful in the diagnosis of TOS. In this report, we describe a patient with debilitating migraines, which were consistently preceded by unilateral arm swelling. Beware that normalization of breathing should be reintroduced slowly, often over the course of years, in patients with TOS, especially in those whom symptoms are severe. The conservative physiotherapy regimen outlined in this article will be suitable for patients presenting with TOS where there is a strong postural contribution to their symptoms. South Med J. None of them seem to understand. [online]. Privacy policy, How to truly identify and treat thoracic outlet syndrome (TOS). In cases where the SCV has occluded and clotted like in my case. Rather, clenching of the PF can cause painful syndromes, especially coital pain. To provide you with the most relevant and helpful information, and understand which A new single maneuver useful in the diagnosis of thoracic outlet syndrome. The droopy shoulder syndrome. Surgeons have told me mixed things about scalenectomy-only surgery; one of the main things is the risk for reattachment to the rib after snipping it. Only two patients showed unequivocal poststenotic dilatation as evidence of severe anterior scalene muscle compression. It happens when the nerves or blood vessels just below your neck are compressed, or squeezed. Due to continuous compression within spaces that the nerves and vessels pass through. Weakness and fatigue are not always seen in the same light as weakness. i appear to be having arteial tos symptoms, just had one of my worse cold and white hand episodes. 2014;203:1303-09. Make a donation. PMID: 15474397. This may however be cheated, by anteriorly rotating the scapula, which is a main trait when in slouching shoulders. Im worried that Im rushing into rib resection surgery when there may be a more conservative approach first through what you outlined: physio, posture fixing, scalene exercises, correcting breathing, etc. I always loved your YouTube videos. Sweating more often (when I first get up in the morning)? Thoracic outlet syndrome (TOS) refers to the compression of one or more of the neurovascular structures traversing the superior aperture of the chest. However; the trapezius is clearly active, holding the scapula in proper height while also upwardly & posteriorly rotating it. I usethese tests almost every day, and they will show up negative if there is not nervous irritation in the region youre testing. Be aware though, that the actual treatmentis a demandingprocedure that will have to be managed through cooperation with a qualified therapist. Sympathetic comorbidity such as tremors, Reynauds syndrome or causalgia may develop. Usually, people with ATOS don't have any symptoms in their neck or shoulder. Symptoms of neurogenic-TOS vary widely depending on the site of impingement and parts of the brachial plexus involved. Electromyogr Clin Neurophysiol. Arterial thoracic outlet syndrome causes symptoms that affect your fingers, hands or entire arm. become squeezed in some waysay, between a rib and an overlying muscle. Although, perhaps, a less popular topic, it must be stated that a lot of TOS cases develop secondary to stress (Scaer 2011, Korn 2021). Blood clots often form around the damaged inner surface of the compressed vein. Breathing habits will need to be worked on, especially with regards to thoracic vertical expansion during inhalation. N-TOS results from compression or irritation to the brachial plexus's lower trunk or medial cord. 2015, vol.53, n.1. In contrast, compression of the predominantly deeper sensory fibers elicits impulses that are appreciated by the brain as deep pain originating in the arm or the chest wall, even if the source of the impulses is cardiac (referred pain). Signs That You May Have Thoracic Outlet Syndrome Regardless of what type of TOS a person may be suffering from, there are several tell-tale symptoms that could indicate that they have TOS, including: Pain, numbness or tingling in the arm, forearm or fingers Loss of pulse in the wrist Swollen, bluish arm Clumsiness of the affected arm They include: Pain in the neck, shoulder, or arm Numbness and tingling Swelling Weakness Discoloration. 1983 Mar;83(3):461-3. doi: 10.1378/chest.83.3.461. You are the man!!! Symptoms of thoracic outlet syndrome differ depending on the type of TOS someone has. McBane RD (expert opinion). Utility (or futility?) you might call your own sanity into question. In some cases, however, your doctor may recommend surgery. Do you know if it can be difficult to see a vascular TOS with ultrasound, even be false negative? We want a posture that remains the head, cervical spine and clavicle in optimal position. https://orthoinfo.aaos.org/en/diseases--conditions/thoracic-outlet-syndrome. This understandable! The Massachusetts General Hospital Division of Thoracic Surgery provides comprehensive evaluation and treatment for patients of all ages with all forms of thoracic outlet syndrome, including neurogenic, venous and arterial. Hello Kjetil, I have a background on pilates & they say you have to activate TVA & pelvic floor to change your posture. Why you should NEVER pull the shoulders back and down. The patient must be cued to stop bracing, and rest more. Ignore the muscle size, it is not important nor a criteria for proper positioning. Rotational vertebrobasilar insufficiency as a component of thoracic outlet syndrome resulting in transient blindness. The exact cause of TOS is unknown, but there are situations that are more likely to squeeze the nerves, veins, or arteries in the thoracic outlet and cause TOS. When these symptoms occur transiently due to head movement, compression of the vertebral artery by an extraluminal lesion should be suspected. I want to do your Scalenus anterior & medius exercises, but can not lie on my side, because I have Ehlers Danlos Syndrome, and my shoulders sublux/dislocate in that position. Therefore, the authors believe that abnormalities in this muscle may cause sympathetic cardiac hyperactivity. They synapse in the dorsal gray matter of the spinal cord, and the axons of the second-order neurons ascend in the spinal cord up to the brain. Accessed July 6, 2021. Acta Neurochir Suppl. Int J Shoulder Surg. Thank you very much for your educational and specific information. The therapist may also force the clavicle caudally. I also, just found out that I have elongated styloids on both sides. Many breathing experts claim that diaphragmatic (belly)-breathing is the ultimate cure to virtually anything. Aralasmak et al., 2010. that we have to eliminate all the inflammations and triggerpoints in the 10 muscles that compress the tos, before we Beginn to strenght. Classically it presents with neurological symptoms from the posterior brain and cerebellum [4,6]. In my experience, its a great and even potentially dangerous myth to assume that these tight muscles are over active and mandate release. Thoracic outlet syndrome (TOS) may affect neurologic or vascular structures, or both, depending on the component of the neurovascular bundle predominantly compressed. In addition to the typical symptoms of arm swelling and paresthesias, headaches have been reported as a potential symptom of TOS. Its presence can block or interfere with the small opening that nerves and blood vessels pass through from the neck to the arm, especially when the arm is raised. When the somatic nerves such as the brachial plexus are entrapped, the dysfunction may bleed over into the autonomic chains, just as a lumbar disc herniation may cause pain from the back down intothe foot. I have written extensively about the topic of correcting swayback posture numerous times in my other norwegian articles, but also in this lower back article in english. We have to force the body to re-engage those scalenes. Possible symptoms are: Pain. A branch of the subclavian artery include a key vessel, the vertebral artery. Neurosurgery. It is caused by trauma, repetitive movements, exertion, anatomic narrowing of the muscles or . Optimization of thoracic vs. diaphragmatic breathing balance will also stimulate the scalenes, as mentioned earlier. neck, head and ears. The infamous thoracic outlet syndrome. . Thoracic outlet syndrome. Thoracic outlet syndrome in brief. I have also seen associations between autonomic irritation and atrialfibrillation. However the vast majority of patients are asymptomatic and rarely require any intervention [3,5,11]. Thank you for this amazing info. Thanks for your helpful artikle about TOS. Neuroradiology. Urschel HC, Razzuk MA, Hyland JW, et al. Often, a very reduced vertical expansion will be noted. Wearing heavy gloves can help also. Vascular Medicine. hi Kjetil, thank you for this how to guide. Rotational Obstruction of the Vertebral Artery Due to Redundancy and Extraluminal Cervical Fascial Bands. Generally, review this video: I live in South Africa and wish that our doctors had more knowledge on this syndrome. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. It is ridiculous what has happened to our healthcare system. Pain can be present on an intermittent or permanent basis. PMID: 4000441. Talk to our Chatbot to narrow down your search. Dont get me wrong though; strengthening workis important. The vein itself must also be treated. Sympathetic system may promote arrhythmia by increasing Ca2+transient. PMID: 17307751. it went . Daily stretches focusing on the chest, neck and shoulders can help improve shoulder muscle strength and prevent thoracic outlet syndrome. The patient may also complain of altered or absent sensation, weakness, fatigue, a feeling of heaviness in the arm and hand. There are three general types of thoracic outlet syndrome: It's possible to have a mix of the three different types of thoracic outlet syndrome, with multiple parts of the thoracic outlet being compressed. I will be booking an appointment with you soon. Its hard work, but well worth it. Surgery and anticoagulation therapy!! Watson LA, Pizzari T, Balster S. Thoracic outlet syndrome Part 2: Conservative management of thoracic outlet. The classic, most common symptoms are pain, numbness, and tingling that radiates below the shoulder down towards the hand and usually into the pinky and ring finger. As usual, squeeze into the interval with your thumb to see whether the symptoms reproduce. I get tingling sometimes and weakness. Kojima N, Tamaki N, Fujita K, Matsumoto S. Vertebral artery occlusion at the narrowed scalenovertebral angle: mechanical vertebral occlusion in the distal first portion. You may opt-out of email communications at any time by clicking on Watch my video on how to do it properly. found to be an anatomical abnormality or variation, such as a deformed rib or a fibrous However, the vagus and phrenic nerves have a different course than the above-mentioned, yet are also related to the scalenes. The latter being the most sinister compression site. Available from: https://www.psychologytoday.com/us/blog/rhythms-recovery/202102/little-known-symptom-ptsd-and-pandemic-anxiety. Anterior scalene muscle 2. PT probably made you worse. Forensic medical aspects. Swelling. The cause of thecompression is mainly tightness of the surrounding muscles and clavicular depression, strangulating the thoracic outlet vascular and nervous structures. If the posture, breathing, and neurogenic pressure-testing all have indications of dysfunction, and of course that the patient presents with additional vascular symptoms, they may very well be caused by vascular thoracic outlet compression. Clin Orthop Surg. As the problem progresses, weakness of the triceps and wrist flexors (radial nerve, C7 nerve root) and medial deltoid (C5 nerve root) may occur. Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures. Head and neck trauma - Physical trauma to the head and neck can induce tinnitus. Twenty-one patients (mean age, 37 years) with TOS and 23 control subjects (mean age, 34 years) were included. This test can also be falsely negative if there is numbness of the nerves (a consequence of long term compression), so dont rely fully on it. In turn, severe inhibition of the scalenes will often develop over time. Elsevier; 2022. https://www.clinicalkey.com. She was also very tired. for a week I felt like a different person, I was cheerful energy and strong, there was no whistling (ringing), my nose was breathing. In neurogenic thoracic outlet syndrome, nerve compromise can lead to . 2015; doi: 10.1177/1358863X15598391. information is beneficial, we may combine your email and website usage information with If you're at risk for thoracic outlet compression, avoid repetitive movements and lifting heavy objects. Thoracic Outlet Syndrome (TOS) refers to an ill-defined assortment of disorders originating Usually slight speed changes, but large signal changes are seen in patients with non-acute pathology, such as TOS-related migraines or similar. If it hurts, there is a problem. And even though I hadnt touched her yet, I knew based on this and the history that this was TOS. Note the difference in echogenicity between the sternocleidomastoid (scm) and scalenes (white structures = fat; the muscle should be relatively dark). Of course, time was starting to take its toll. If significant weakness is discovered, it is an utmost high priority to decompress the CCS. This is a great article and explains a lot. Review/update the If they do, you can MMT the teres major and minor, or just initiate a strengthening protocol right away as theyll test weak anyway. Liebe Gre. Masks are required inside all of our care facilities. *If you are experiencing pain or as a result of Thoracic Outlet Syndrome - please give ProTailored Physical Therapy a call today at 260-739-0300 . Fig. Symptoms usually only appear on one side of the body. It is clear that the irritation of the cervical sympathetic plexus comes from entrapment of thethoracic outlet. I had my Tos surgery 20th august 2022. The symptoms of thoracic outlet syndrome depend on the type of TOS. We get treated like lab rats being sent from one 15 minute appointment to the next. MMT is a skill that takes time to develop, but is extremely usefulwhen you get good at it. 914 390 028 the doctors again excelled, they saw compression only on the third attempt))))) Well, after that I myself saw the kimmerly rings on the MRI images.so I suppose that maybe there is still a little scalenus syndrome. The most common sign is a dull ache or numbness in one arm. Its an interesting question. Post-rib resectionvenogram: A procedure done two or three weeks after TOS surgery to check any remaining damage to the vein; the vein can usually be treated with balloonangioplasty, in which a balloon is used to expand the narrowed vein. Dear Kjetil Rather, this is probably just some kind of bracing issue and youre using the wrong muscles. So informative. The somatic nervous system and autonomic nervous system is interconnected through something called gray rami communicans. Neurogenic TOS (N-TOS) is the most common cause of TOS, accounting for over 95% of all cases. headaches. Mayo Clinic. In most cases, the vertebral artery arose at the level of the thyrocervical trunk and the compression was relieved by section of the scalenus anticus muscle and by division of the inferior thyroid artery. This animation illustrates how physicians at the Johns Hopkins Thoracic Outlet Syndrome Clinic perform interscalene brachial plexus blocks using botulinum toxin type A injections to provide temporary pain relief for patients. Pain was present in the neck, shoulder, arm and hand, chest . Dont trust this, as its just the bodys protective response. When nerves are compressed, signs and symptoms of neurogenic thoracic outlet syndrome include: Signs and symptoms of venous thoracic outlet syndrome can include: Signs and symptoms of arterial thoracic outlet syndrome can include: See your doctor if you consistently experience any of the signs and symptoms of thoracic outlet syndrome. See some interesting evidence below. i had a posterior dislocation of my sternocavicular joint and my hypertonic scm seems to be more of an issue than my scalenes. Demondion et al., 2006. Sanders RJ, Hammond SL, Rao NM. I cant tell you anything specific without consulting with you. Chahwala V, Tashiro J, Li X, Baqai A, Rey J, Robinson HR. The reason why a person could have a weak grip is by repetitive movements that over time has caused the injury. Ulnar neuralgia or paresthesia is also a common initial symptoms of TOS, as the C8 and T1 roots lie more susceptible for compression in the costoclavicular interval. Evaluation begins with most or all of the following: Complete medical history and review of symptoms, Physical maneuvers (movements) to provoke symptoms. Despite more than 2600 references to TOS on pubmed, there is still wide controversy regarding TOS; no concrete diagnostic criteria have been established, and many practitioners claim that the whole problem is a fad which does not really exist. Fig. Symptoms in the upper extremity are a result of thromboembolization . At exploration, the phrenic nerve was found adhered to the brachial plexus. Id also be interested in possibly skyping with you. She was fine a few days after, but was of course mortified of starting those exercises again. 1., and mainly, because the collar bone is too low during articulation of the arm. Cant understand this symptom, have you seen patients with this symptoms and get a good to go to start your program? I strongly suggest that you book a consult. Amazing article, and so informative. The scalenes are pulling them up. At Another Johns Hopkins Member Hospital: If you have a new or existing heart problem, it's vital to see a doctor. I know you mention that when you start strengthening the scalenes and other supporting muscles, symptoms could get worse at first. This in turn may cause severe tightening of the scalenes, compressing all of the thoracic outlets structures and may thus (with potential) cause all of the formerly mentioned symptoms. Im really on the fence for what to do. Xi & Cheng, 2015, Symathetically mediated atrial fibrillation is observed in the presence of any heart disease, the first effect of which is to provoke a vagal withdrawal. They should never be pulled down. The point here is to assess the specific muscles functions, not to win. 1990;32(6):514-5. doi: 10.1007/BF02426468. PMID: 19008742. Symptoms may come and go, but they are often made worse when arms are held up. It may also cause pain, numbness, or tingling on the inside of the forearm and the fourth and fifth fingers of the hand. Even in incidences of successful surgery, residual entrapment in the periphery may forelie. At night, lying on your back, you wake up with a slight dizziness, which passes quickly. Breaking your neck certainly didnt make your neck muscles stronger. Subclavian steal syndrome. Remember that the clavicle shouldelevate gently as you breathe in, and gently depress as you breathe out. I found your site and did the head exercise, not letting it reach the floor seemed to have helped a lot. If symptoms appear within 15-30 seconds while still lying on the table, thismay indicate vertebral artery dissection (VAD). At the root of all TOS problems is pressure or compression on nerves or blood vessels Thanks again. Neurology. Surgical exploration revealed entrapment of the left vertebral artery by a tight anterior scalene muscle, release of which resulted in complete resolution of her symptoms. Check the full list of possible causes and conditions now! Venous TOS occurs when a vein is compressed, leading to upper body thrombosis. Just wondering what are you studying on TOS ? Fair request, Ill write some extra material for this topic. Selmonosky CA. They are not unique, and this is one of the main reasons why making a diagnosis is difficult. 1. Yes, if you go too low it will compress the plexus. Hanging forward with the head and slouching with the shoulders will inhibit the scalenes ability to elevate the ribs during inspiration, exacerbatingthe dysfunction. https://youtu.be/HezNZkdt4Ug. About I was diagnosed with neurogenic thoracic outlet syndrome with complications. Symptoms include pain, tingling or weakness in the shoulder and arm, especially when raising the arms. Kuhn JE, et al. Coracobrachialis muscle 8. Is this something I should be concerned about, or have you seen this before? Thoracic radiculopathy is irritation or . Therefore it will not be elaborated further in this article, but it is paramount that the reader understands the chain reactionsof pelvic misalignment on the head, neck and shoulders. Eur Heart J. Web article. 2010;18(2):74-83. doi:10.1179/106698110X12640740712734. The carpal tunnel is a little different than the rest of the compression points in this article. Raising the shoulders slightly in posture (and staying there) will decompressthe thoracic outlet. EDS is genetic with a cascade of comorbidities and POTS is a common comorbidity, why wouldnt a ten year old be able to be diagnosed with them? Open Access MR Imaging Findings in Brachial Plexopathy with Thoracic Outlet Syndrome. 2. Pain from shoulder to fingertips. This can be rooted in habits alone, or triggered by injuries such as a clavicular fracture (Moon Jib Yoo et al., 2009; Ishimaru et a., 2012; Connolly & Dehne, 1989), whiplash injury (Schenardi, 2005) or similar. It will only affect the inferior proximal mandible and ear though. Yes, because it raises head arterial pressure (and this lowers body pressure). Swelling. Journal of the American Academy of Orthopaedic Surgeons. The particular nerves and blood vessels compressed Hand Clin. Robey JH, Boyle KL. A single copy of these materials may be reprinted for noncommercial personal use only. If its weak, and it usually is, strengthen it. TOS comprises a group of diverse disorders that involve the compression of the nerves, arteries and veins in a region enclosed between the lower neck and the upper chest.. TOS also includes the scalene/scalenus entrapment syndrome caused by the hypertonic anterior scalenus or scalene muscle compressing the brachial plexus and subclavian artery against the . Muscle soreness or pain. If it does, MMT it by having the client resist your attempt to supinate their wrist. Learn more about the tranaxillary first rib resection surgical approach to treat TOS from the Johns Hopkins Thoracic Outlet Syndrome Clinic. The interscalenetriangle is usually the main entrapment point (culprit), and will often stand for 60-80% of the patients symptoms. Wish you were in the US! Rotational vertebrobasilar insufficiency secondary to vertebral artery occlusion from fibrous band of the longus coli muscle. Bodybuilding: Built-up muscles in the neck may grow too large and compress nerves or the subclavian vessels. Fig. It may get better for an hour or so, but then comes back with a vengeance. Ive gotten more information about tos by reading this one article than seeing a bunch of doctors for over a year now. 2004, Four patients with elevated creatine phosphokinase (CPK) values and recurrent chest pain were found to have thoracic outlet syndrome. Ever since the surgery I have had a red swollen arm, dilated veins that make my arm and hand feel like they are going to explode. Most of the time, however, the scapula is so depressed that even with anterior rotation it will not be in line with T2, such as with the person in the picture below. Talk to our Chatbot to narrow down your search. The (anterior and medial) scalenes are involved in many actions. Heres a patient with ipsilateral migraine and facial numbness. They are the result arteriolar vasoconstriction brought on by sympathetic nerve stimulation from compression of the sympathetic nerve fibers that accompany the C7 and C8 nerve roots[2]. My scap is usually in pain and my shoulder feels numb and whole arm feels heavy and dead. A central diagnostic question to be faced is whether the pain and tingling in the arm is caused by a nerve root issue, as in a severely compromised intervertebral foramen, or in the thoracic outlet. They may be used to quantify the problem, once already implicated, however. Compressed nerves can cause: pain in parts of the. Going on hard on these exercises may trigger tremendous pain and significant worsening of the symptoms. Amazing write up. Research has demonstrated a connection between compression of the subclavian artery and compromise of the vertebral artery, an artery that supplies the posterior brain with blood. Thoracic outlet syndrome: a review. Silva & Selmonosky, 2011, The diagnosis of neurogenic TOS is more challenging because its symptoms of nerve compression are not unique Sanders et al., 2008, Conversely, no valid standard diagnostic test is available for disputed neurogenic TOS, resulting in controversies in the frequency of TOS diagnosis Hooper et al., 2010, Diagnosis and treatment of thoracic outlet syndrome (TOS) involves neurologists, physiatrists, family physicians, orthopedic surgeons, vascular surgeons, thoracic surgeons, neurosurgeons and sometimes psychiatrists. Since I started exercises and posture correction changes listed in these 2 articles 1 month ago, I have absent or barely any pain if I keep my L shoulder up but it definitely still has to be conscious act. Alcocer et al., 2013, This article describes migraine without aura since childhood in a patient with bilateral cervical ribs. The patient may feel like stretching a steel wire that wont budge when stretching a weak and inhibited muscle. The problem is that the reference ranges for these scans are very wide, and it is very easy to get a false negative. in a position similar to that of DeKleyns (VAD) test shows significant loss of flow volume, indicated by obliteration of signal. Heres the problem. Symptoms of thoracic outlet syndrome relate to the compression of blood vessels and nerves. Please consider that back and down is a provocative (orthopaedic) test for costoclavicular space syndrome (Magee, DJ. Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. I have been trying to follow some of your programs and it seems to be affecting my vagus nerve and causing a lot of anxiety. 2). I told her to take some NSAIDS, which helped some. National Institute of Neurological Disorders and Stroke. in the passageway between the neck and chest called the thoracic outlet. The retropectoralis minor space is a very rare potential site of compression. First of all, neurogenic TOS is in general misdiagnosed, overlooked, etc even though it is the most easily triggered type of pain. Moreover, it is sometimes strongly denied by those who have not had the opportunity of identifying it as a disease or even when they have not dealt with TOS patients. Orthopedic physical assessment, 2014). Would a knotted muscle in the neck or suprascrapular area cause symptoms similar to TOS? The takeaway is therefore to very gradually reintroduce chest breathing and to closely monitor your symptoms during this period to avoid progressive overloading and inflammation of the scalenes. May be overworking.