From the Desk of Robert B. Haase, LMT:
I would like to offer some insight to my fellow therapists and physicians regarding my clinical observations regarding the complications of Thoracic Outlet Syndrome from large submuscular (subpecular) breast augmentation. This a common dynamic I have observed over my 26-years in the massage profession and it can be successfully treated with deep tissue treatment.
As you may know, I have been teaching deep tissue and injury treatment seminars over the past two decades. My experience includes a two-year tenure as an autopsy assistant for the country coroner, working in tandem with medical doctors in clinical and hospital settings, as well as providing tens of thousands of treatments over the span of my career.
Like I tell my students, "Just because you see two things happen at the same time doesn't mean they are related". If you see it consistently, however, there certainly might be a correlation.
What I have seen, on a consistent basis, is an occasional complication when treating Thoracic Outlet Syndrome which adds to its complexity, ultimately delaying and potentially preventing recovery.
This past month I met a woman who told me how she had been the victim of an assault. For the past two years, she has suffered from numbness in her arms and hands and nothing was working to alleviate her symptoms. She had been treated by the best doctors in the country at some of the best hospitals but was still suffering.
Without sounding inappropriate, I will just say it was visually apparent that she likely had breast augmentation. Our conversation went something like this...
Me: "Did your symptoms of numbness follow the assault?"
Woman: "Yes. It's frustrating because I can't go back to work or even drive when I can't really feel my arms and hands. It isn't safe."
Me: "Forgive me for asking, but have you had breast augmentation?"
Woman: "Yes" (She raised an eyebrow from my question.)
Me: "Was the augmentation prior to the assault?"
Woman: "Yes" (The leery look continued)
Me: "Are your implants over 350cc in size and are they under the 'chest' muscle?"
Woman: "These are seriously weird questions for a 'massage therapist' to be asking, don't you think? But yes, they are over 350cc in size and they are under the muscle."
Me: "Well... let me explain..."
What I told the woman was the same thing I have been teaching the students in my seminars in recent years. The common issue is found in women who have had breast augmentation with large implants, usually over 350cc in size, and the implants were inserted under the pectoralis major. With "subpecular" implants, the pectoralis major muscle is used as somewhat of a "sling". Although the implant isn't entirely covered by the muscle on the lower aspect, the adhesions which form around the bag's rough surface tend to complete the sling effect.
With larger implants, the weight ultimately ends up pulling down or depressing the clavicle. Meanwhile, the "whiplash muscles" (anterior and middle Scalenes) shorten and end tend to elevate and rotate the first rib, causing it to press into the clavicle. The problem is the nerve (Brachial Plexus) that passes between the first rib and clavicle "feeds" the arm and ultimately gets pinched (Thoracic Outlet Syndrome). Exacerbating the issue is the Pectoralis Minor which often gets injured in motor vehicle accidents, adding to the compression of the Brachial Plexus.
When you have:
...Trifecta! You have what is often referred to as "triple crush syndrome."
Back to the conversation...
Me: "I can fix that."
Woman: "That's pretty arrogant considering all of the treatment I've had from exceptional doctors."
Me: "I've been accused of arrogance on more than one occasion. It's actually confidence, not arrogance. All I need to do is release and lengthen the Pectoralis Major's fibers, release the spasms and lengthen your Pectoralis Minor and Scalene muscles, and then help the first rib to return to where it wants to be, with steady and direct pressure, taking it through its 'range of motion.'"
[Note: The pressure on the rib is not an adjustment, but simply taking the rib through its range of motion without
interference from muscular tension.]
Me: "One treatment and you'll see. Plus, I won't charge you if it doesn't work."
It is an even longer story, but the short version is this: (1) 15-minute treatment resulted in the return of her normal sensations in her arm, increased circulation
and warmth, and the full use of her hands. The woman was in tears - more than grateful - and extremely upset at the money and time she had "wasted" when something so simple could restore her quality
of life much sooner.
So, the next time a woman says she had some sort of MVA or other physical trauma around her neck and shoulders, has numb arms and hands and the appearance of augmentation, perhaps you can be more tactful than I was. Life is short, so I tend to get to the point.
Until next time, keep Changing the World, One Massage at a Time.
Robert B. Haase, LMT
Haase Seminars & Consulting