Thoracic Outlet Syndrome

Double crush syndrome refers to the compression of the same nerve at two points: the cervical spine (nerve root) and the thoracic outlet. The concept is that a nerve compressed in one place becomes more vulnerable to compression in the other. Clinically, a significant number of patients who remain with arm numbness even after receiving treatment solely for a cervical disc have concomitant thoracic outlet compression. The key differentiating factors are the distribution of numbness (disc herniation involves distribution to specific nerve roots, while thoracic outlet herniation is predominant from the inner arm to the 4th and 5th fingers) and the provoking posture (worsening with arm elevation suggests thoracic outlet herniation); treating both lesions within the same treatment plan yields better results. In Korean medicine, we view the entire flow known as meridians rather than a single nerve strand; therefore, we examine the entire path from the neck to the forearm as a single pathway. Whether the compression is in the cervical spine or the thoracic outlet, it ultimately indicates a blockage in the circulation of Qi and blood along the same meridian. When both locations are blocked, it signifies a breakdown in circulation across that entire pathway. At Dongjedang, we treat the deep muscles surrounding the cervical spine, as well as the scalene and pectoralis minor muscles, together within a single treatment. We relieve tension along the entire pathway using acupuncture and separate distinct adhesions using ultrasound-guided needles. The key to treating the co-morbidity lies in correcting the underlying cause of the two lesions—poor circulation—by adding internal treatment to clear blood stasis and dampness accumulated from prolonged physical labor and replenish qi and blood.