Thoracic Outlet Syndrome

What is Thoracic Outlet Syndrome?

The thoracic outlet is the area between the base of the neck and armpit through which the blood vessels and nerves pass. Thoracic outlet syndrome (TOS) is a condition that arises from pressure being placed on nerves or blood vessels. Pressure on the blood vessels can result in blood clots in the major veins of the arm. The result is pain in the arm, neck, or shoulder.

TOS is sometimes associated with a congenital abnormality of an extra
rib (or “cervical rib”). There may be a history of a traumatic blow to the shoulder or neck. Poor posture and obesity can also aggravate this condition, which is more common among women than men.

Causes and risk factors for Thoracic Outlet Syndrome

Symptoms of Thoracic Outlet Syndrome

The symptoms of TOS vary depending on whether nerves, arteries, or
veins in the thoracic outlet are compressed.

  • Nerve compression (this accounts for about 95% or TOS cases)
    • arm pain, numbness, and tingling
  • Venous compression (3 to 4 percent of TOS cases)
    • arm pain and swelling.
  • Arterial compression (the rarest type of TOS)
    • hand ischemia (lack of oxygen) – may lead to limb loss

Although symptoms vary depending on whether a nerve or blood vessel has been affected, many times more than one system (nerves, veins, arteries) is involved. Diagnosing TOS can also be difficult since many other conditions cause similar symptoms (for example: carpal tunnel syndrome, shoulder tendonitis, cervical disc disease and fibromyalgia.

Symptoms a health care provider will be looking for include…

  • Reduced pulse in the arm when the arm is held in certain overhead positions or while turning the head far to one side
  • Swelling of the arm
  • Very prominent veins in the arm
  • Discoloration of the fingers
  • Limited range of motion for the arm
  • Reduced ability to feel pinpricks or temperature changes
  • Abnormal blood vessel sounds during a stethoscope examination of the shoulder area

Diagnosing Thoracic Outlet Syndrome

To confirm whether or not a patient has TOS, the following tests may be performed…

Treatment Options

Treatment for TOS depends on the symptoms. If an extra rib is present, or there are problems with arm artery or vein are present, these underlying causes will be treated first, otherwise, the usual first treatment is

  • Physical therapy – to strengthen the muscles supporting the thoracic outlet area

Other treatments might include…

  • Muscle relaxants
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Application of moist heat
  • Massage
  • Pain relievers
  • Short courses of steroids
  • Lifestyle changes to improve recovery
    • Maintain correct posture while working
    • Take frequent stretch breaks
    • Lose weight if overweight
    • Avoiding carrying heavy bags over the affected shoulder
    • Evaluate and redesign the workplace to make it ergonomically correct
    • Occasionally, occupational change may be needed

In severe cases…

  • TOS decompression surgery – to relieve the source of compression or eliminate scar tissue.

In cases where the TOS is caused by a blood clot…

  • Thrombolysis – removal of a blood clot by administering a clot dissolving medication directly
    into the arm vein

In cases where TOS is caused by a damaged artery…

Our surgeons who treat thoracic outlet syndrome

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