Thoracic Outlet Imaging

Hello, Can you tell me whether there is any way to do any imaging studies for thoracic outlet while sitting up?

I fell last Aug on outstretched arms and something is now causing my jugular to bulge like it will burst whenever I pull back on the shoulder or try to raise my arm.

But I have a frozen shoulder so unable to do the MRI test where the arm is raised, to diagnose TOS.

The veins in my right arm are also swollen, but go down when I am cold, lay down, or raise the arm some.

Since the arm veins go down when laying down, an ultra sound shows no compression anywhere. I am at a loss as what to do next and so are conventional doctors. Physical Therapy is not helping much so I'm thinking of trying a chiropractor but don't know what more can be done.

I have a clunking when swallowing so I'm thinking that a muscle or something may be causing a problem in the neck as your image illustrates. But the muscles in the arm chest area are very tight, so the problem could be there too. Can you give me some direction as to whether there is anything that can be done please? This is getting progressively worse and I would like to find a solution before clots develop.

Thanks in advance!!


Hello Penny,
Obviously you have a difficult problem and I don't want to suggest there is any easy chiropractic solution. I doubt there is.

Firstly, the fact that the swelling goes down when you RAISE your arm confirms that this may be a thoracic outlet syndrome. But... the vein from the arm doesn't pass through the thoracic outlet usually.

In practice, I almost always find that a frozen shoulder is associated with a first rib fixation, also the cause of many thoracic outlet syndrome cases.

There are new fancy MRI studies that can be done standing or sitting. Shop around.

Have you ever heard, or has anyone done the Adson's test on you. Use the SiteSearch function at Chiropractic Help. It involves testing the pulse in your wrist whilst turning the head and looking up, and taking a deep breath. It's the basic test for a TOS. Hard to do, and quite subjective.

I have no easy answers. Working on the first rib, the scalene muscles, the frozen shoulder and that midthoracic pain is where I would start.

Other health issues? High blood pressure, obese, diabetes? Smoker?

I'm not sure this contributes, but good luck anyway.

Dr B

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Feb 23, 2013
Re: Thoracic Outlet Imaging - Thank You
by: Penny

Thank you so much for your fast and helpful reply!! I will start looking around to find where I can go for this imaging.  You mentioned that a frozen shoulder is associated with a first rib fixation?  Is it possible that the fixation of the first rib will go back to normal when my frozen shoulder resolves? The veins began protruding in the arm at the same time that I started losing range of motion, so I am hoping that blood vessel constriction will resolve when my frozen shoulder resolves.  But from what I have read, that does not sound likely.   I was also told that I have a partial tear in the rotator cuff, so I don't know whether that factors in. 

Another thing that could be causing problems is that it feels like the muscles around the shoulder area are shortening and tightening.   When using the arm, the pulling feeling extends into the neck, back and chest area.  Massage helps loosen them, temporarily, but the blood vessels continue to protrude.   

Otherwise,  my health is good.  I've never smoked, not overweight, blood pressure has always been low 110/70 (but is now higher,  140/90, probably due to the stress of seeing the bulging jugular).  The  stress seemed to be making the muscles even tighter, so my doctor gave me something to relax.  That seems to temporarily help loosen the muscles, but has no affect on the venous constriction.   They  did perform a test where they felt my pulse while I moved in various ways  (I assume this was an Adson's test) but a pulse was still felt in the wrist.  They don't know what to do with me, so I am really hoping that I will be able to find someplace that has one of the newer MRI's to help locate the source of the constriction.  Thanks again for all your help!

It's great that your general health is good, Penny. That's a big plus.

Your situation needs both medical and chiropractic care. What's still not clear is the cause of the vascular constriction, and that needs to be clarified. I take it you've been to a vascular surgeon.

The subclavian vein does occasionally as a normal variant pass through the inter scalene triangle, but it is the exception.

You can be sure that this tightness in the chest and neck, the frozen shoulder, the rotator cuff tear and the swollen veins are all connected.

At C-H you'll find some "frozen shoulder exercises". Use the SiteSearch function and start doing them daily. Start slowly.

Look for an experienced chiropractor in your area who has experience in dealing with frozen shoulders. Sorry I'm not nearer...!

Dr B

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