From the desk of Beth Loy, Ph.D., Principal Consultant/Technical Specialist
If you ever had a course in human physiology, you probably learned that the area between the collarbone and the first rib is called the thoracic outlet. Although it might be forgettable from a course full of concepts surrounding the entire body, to those with thoracic outlet syndrome (TOC) it is impossible to forget. TOC is a painful condition that results from compression and a narrowing of the blood vessels or nerves in this area.
TOC can result in tingling, weakness, and numbness down the arm of the affected side. Pain can resonate in the shoulder, collarbone, neck, and upper back region. The condition could be from trauma or injury, repetitive stress, tumors, poor posture, having a cervical rib (an extra rib), and pregnancy. Treatment often involves exercises, pain relief, relaxation exercises, physical therapy, stretching, nerve blocking injections, and surgery. Pain can be chronic, lasting for extended amounts of time.
At JAN we receive accommodation questions involving individuals with TOC for all types of work. Limitations, although usually focused to one side of the upper body, can make it difficult for those involved in lifting, reaching, or sedentary positions. Here are a few situations:
- Rohn is a graphic designer who, due to TOC, was having difficulty using a keyboard and mouse for long periods. One of his job duties was to put together a monthly newsletter for his company. To assist with this, Rohn’s employer provided speech recognition and a joystick mouse that could be alternated between the left and right side.
- Celia was a financial analyst who had pain down her left arm due to TOC. She entered a physical therapy program to help manage her symptoms. As a part of this program, she received nerve blocking injections. Celia was provided flexible scheduling so that she could attend therapy and receive injections two afternoons a week.
- Leah was a paralegal at a large law firm. She was injured in a bus accident and wanted to return to work with limitations from TOC. Leah was able to return after her employer provided her with a sit/stand workstation and flexible scheduling, which included breaks so she could do her stretching exercises.
- Gregory was a diesel mechanic who developed TOC on his right side, which was his dominant side. He learned in the process of his diagnosis that he was born with an extra rib, a cervical rib. Gregory underwent surgery to remove this rib. He then entered a rehabilitation program to regain strength in his right side. During this time, he was provided with leave as an accommodation.
- Jeremy specialized in computer security and was responsible for several subcontracts. He developed TOC and needed adjustments to his workstation. His employer provided an ergonomic assessment and purchased an adjustable workstation along with a new ergonomic chair, alternative mouse and keyboard, and double monitor system.
- Jenna was a librarian who helped oversee books and microfiche on multiple floors of a large library. At times, Jenna filled in for library assistants, whose job it was to restack books. After developing TOC, she asked that this marginal function be removed from her duties. Her employer agreed, and Jenna was able to continue working.
It’s clear that limitations for TOC can vary. However, it’s also apparent that an individual’s limitations are dictated by pain and those job functions considered essential dictate accommodations. For additional information on accommodations for TOC, see JAN’s A to Z By Limitation.