• Entrapment of the Median Nerve between the wrist bones and transverse carpal ligament.  
  • Tingling often occurs at night and sufferers often complain of being awakened at night by the hand "falling asleep"

Pathomechanics - cause to effect


The Rothbarts Foot or the PreClinical Clubfoot Deformity rotates the shoulders and head forward


A forward rotated head contracts the Scalene muscles

  • A contraction of the Scalene muscles compresses the brachial plexus and/or subclavian vessels against the first rib in the thoracic outlet

A forward rotated shoulder contracts the Pectoralis Minor muscles 

  • A contraction of the Pectoralis Minor muscles compresses the brachial plexus and/or subclavian vessels against the head and neck of the humerus

A compression of the brachial plexus and/or subclavian vessels, if severe enough, results in symptoms listed below


Symptoms resulting from Postural Thoracic Outlet Syndrome vary, but can include:

  • Tenderness in the supraclavicular area
  • Tight Scalene muscle
  • Tight Pectoralis Minor muscle
  • Weakness in the arms or hands
  • Pins and needles sensation when elevating the arms above the head
  • Tingling or numbness in the 5th finger (if the entrapment encompasses the Ulnar Nerve)
  • Tingling or numbness in the thumb, index and middle finger (if the entrapment encompasses the Median Nerve)

Postural Thoracic Outlet Syndrome is a term used to describe a compression of the brachial plexus and/or subclavian vessels resulting from a forward rotation of the shoulder and/or head. 

Postural Thoracic Outlet Syndrome

Since the nerves control muscle strength and dexterity as well as sensation, an affected hand may become weak and clumsy, causing difficulty opening jars, opening doors or dropping of objects unexpectedly

Differential Diagnoses include:

  • Rotator cuff injuries
  • Cervical disc disorders
  • Multiple Sclerosis
  • Spinal cord injuries
  • Carpal Tunnel Syndrome