Botox yes! In TOS 1 Superior trapezius usually spastic/hyperdynamic; inducing same-side Pectoralis minor muscle to be spastic/hyperdynamic. These muscles control directional shift of distal clavicle; which, as drawn inferior, closes Thoracic Outlet (1 cm vs. clavicle & 1st rib).
The physical exam should note shoulder asymmetry; one shoulder lower with head usually tilted toward lower shoulder. The tilted 10# head often induces spasm & hypertrophy of Superior trapezius associated with opposite & higher shoulder.
Superior trapezius hyperdynamic function then induces spasm/hypertrophy within same-side opposing (shoulder lift & draw-down are complementary functions) Pectoralis minor (PM) muscle. It is PM hyperdynamic function that draws distal clavicle excessively inferior in TOS disorder.
The clavicle is about 18 cm long & 1 cm of excess inferior shift can close the Thoracic Outlet (TO) by ~30%; impinging brachial neurovascular bundle contents of the TO.
That part of the brachial neural plexus that gives rise to the ulnar nerve is the first part of the brachial neural plexus impinged as Thoracic Outlet closes; anatomical explanation why ulnar paresthesias are most common dysesthesia aroused by arm-shoulder abduction with TOS.
After surgeons failed to cure TOS with flayed/excision of Scalenes (~1980’s theory of TOS etiology), they discovered that Pectoralis muscle release (off corocoid process) & tie-down of first rib to 2nd (axilla surgical entrance) was therapeutic; opened up the Thoracic Outlet.
Yet this surgical approach seems somewhat butchery. Better to reduce “crossed muscle” asymmetry of Superior trapezium (strengthen weaker Superior trapezius with isometric & shrug exercises) & induce muscle relaxation of spastic shoulder muscles with massage, Botox & biofeedback.
The theories and practices referenced in this thread are my own novel insights and inventions; gained from years toiling in the clinical trenches. I have created several other threadreaders about TOS.

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More from @BadgleyLaurence

15 Sep
LONG COVID: etiology of long-COVID, CFS, Fibromyalgia, etc. evolves from acute injury to musculoskeletal tower. Two weeks of intense bedrest, from injury to skeletal tower or viral illness, causes severe soft tissue deconditioning, loss of tissue mass, & weakened body tower...
Greatest force threatening weakened organism is ambient gravitational field: all body parts falling to earth at 32’/sec/sec. As body tower attempts upright station, widespread painful muscle spasms ensue to stiffen tower. Upright posture & even walking become difficult.
A natural response is to lay down & rest. Exercise becomes exhausting. Additional rest magnifies the pathology. As the weakened body tower encounters ground force of sleep/resting site, painful spastic muscles beget REM disruption & non-restorative sleep➡️depression/fatigue.
Read 11 tweets
31 Aug
MUSCULOSKELETAL PAIN has inception in trauma. Most common traumatic force is gravity. Muscles/soft tissues supporting upright body tower experience repetitive stress injure & chronic painful spasm in towers asymmetric within ambient gravitational field.
Asymmetric body towers result from asymmetric pelvises, overlying functional scoliosis, asymmetric shoulders, & chronically tilted heads. This asymmetric musculoskeletal chain is most commonly evoked by unilateral sacroiliac joint subluxations.
It is a peculiar bio-mechanical phenomenon that sacroiliac joint subluxation is most commonly unilateral. Sacroiliac joint subluxation is common; especially in females and especially in those with Hypermobility Syndrome.
Read 7 tweets
28 Aug
POST-PARTYM PAIN: it is a recount I have heard many times. A woman has an epidural during childbirth and then wakes up with everlasting severe low back pain. I have studied these women and can report what happens.
During the epidural anesthesia (from waist down) these women cannot splint & protect ligaments that join ilium to sacrum at the sacroiliac joint. Ligament stretch & tear permanently lossens this major low back joint, the largest joint in the axial spine.
Pain of sacroiliac joint subluxation is excruciating, & in the 1990’s (before opiate bowdlerization) academic pain experts (e.g. Dr. McCarlberg of San Diego Medical School) regarded 80 mg of oxycodone twice daily as beneficial for this pain.
Read 9 tweets
22 Jul
GASTROPARESIS THEORIES: the diagnostic list that accompanied the occurrence of Gastroparesis in this study overlooked the association of Gastroparesis & Hypermobility Spectrum Disorder (HSD).
My clinical observations have included that persons with HSD, mostly women, have a functional scoliosis while upright and a straight spine while prone. Spine disks are no more than ligaments; more flexible in those with HSD.
Thoracic scoliosis might functionally, asymmetrically, & mechanically strain soft tissues of the autonomic nerve system, which includes the Vagus Nerve.
Read 12 tweets
22 Jul
Most thinking people have unacheivable ambitions. “Coping skills” exist in eye of the beholder. “Somatic complaints” are common in the 4+% of women, who suffer from Fibfomyalgia, non-restorative sleep (attendant depression), & the constellation of dysautonomias that ....
follow upon the multitude of joint subluxations found in women with connective tissue variations named Hypermobility Spectrum Disorders; normal morphologies selected by evolutionary pressures for more effective birthing.
That leading virologist miss the associations between tissue variations, musculoskeletal functions, & nervous system disharmonies is understandable. But they should not assume a negative, “somatization”, & a phantom diagnosis that eludes scientific proof.
Read 9 tweets
30 Apr
CROHN’S & TMJ: A patient asked if these disorders are causally related? The answer is “no”. However, in my opinion, there is an association based on underlying genetically-determined tissue disorders.
Hypermobility Spectrum Disorder tissue variations seem to potentiate evolution of these conditions: TMJ=spinal flexibility ➡️ asymmetric shoulders ➡️ unilateral Masseter m. (TMJ etiology). I consider Crohn’s a dysautonomia; aroused by lax-SIJ impingement of the presacral plexus.
A common association is TMJ (Temporal Mandibular Disorder) & IBS in same patient. Tie-in is Hypermobility Spectrum Disorder (HSD). Ligament (connective tissue) laxity exposes upright body tower to gravitational stress deforming the tower; lose joints sublux & impinge nerves.
Read 6 tweets

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