About thoracic outlet syndrome (tos)
What is thoracic outlet syndrome (tos)?
Thoracic outlet syndrome is a condition whereby symptoms are produced from compression of nerves or blood vessels, or both, because of an inadequate passageway through an area (thoracic outlet) between the base of the neck and the armpit.
- Thoracic outlet syndrome symptoms include
- neck pain,
- shoulder pain,
- arm pain,
- numbness and tingling of the fingers,
- impaired circulation to the extremities (causing discoloration).
- Diagnosis of thoracic outlet syndrome is suggested by the symptoms and physical findings and is sometimes supported by electrical and/or radiology tests.
- Treatment of thoracic outlet syndrome usually involves physical-therapy exercises and avoiding certain prolonged positions of the shoulder.
What is thoracic outlet syndrome?
Thoracic outlet syndrome (TOS) is a condition whereby symptoms are produced (such as numbness in fingers, pain in shoulder, arm, and neck) by compression of nerves and/or blood vessels in the upper chest. The passageway for these nerves and blood vessels to exit the chest and supply the upper extremities is referred to as the thoracic outlet. Muscle, bone, and other tissues border the thoracic outlet. Any condition that results in enlargement or movement of these tissues of or near the thoracic outlet can cause the thoracic outlet syndrome. These conditions include muscle enlargement (such as from weight lifting), injuries, an extra rib extending from the neck (cervical rib), weight gain, and rare tumors at the top of the lung. Often no specific cause is detectable.
It is felt by some scientists that the evolution of the torso of primates from a four-legged to a two-legged position may predispose humans to the development of thoracic outlet syndrome. The resulting vertical posture produced flattening of the chest cage and a shift of the shoulder joint backward, both of which narrowed the thoracic outlet.
What are the symptoms for thoracic outlet syndrome (tos)?
Shoulder pain symptom was found in the thoracic outlet syndrome (tos) condition
It's possible to have a mix of the three different types of thoracic outlet syndrome, with multiple parts of the thoracic outlet being compressed.
Thoracic outlet syndrome symptoms can vary depending on the type. When nerves are compressed, signs and symptoms of neurogenic thoracic outlet syndrome include:
- Numbness or tingling in your arm or fingers
- Pain or aches in your neck, shoulder, arm or hand
- Weakening grip
Signs and symptoms of venous thoracic outlet syndrome can include:
- Discoloration of your hand (bluish color)
- Arm Pain and swelling
- Blood clot in veins in the upper area of your body
- Arm Fatigue with activity
- Paleness or abnormal color in one or more fingers or your hand
- Throbbing lump near your collarbone
Signs and symptoms of arterial thoracic outlet syndrome can include:
- Cold fingers, hands or arms
- Hand and arm pain
- Lack of color (pallor) or bluish discoloration (cyanosis) in one or more of your fingers or your entire hand
- Weak or no pulse in the affected arm
What are the causes for thoracic outlet syndrome (tos)?
Thoracic outlet syndrome is usually caused by compression of the nerves or blood vessels in the thoracic outlet, just under your collarbone (clavicle). The cause of the compression varies and can include:
- Anatomical defects. Inherited defects that are present at birth (congenital) may include an extra rib located above the first rib (cervical rib) or an abnormally tight fibrous band connecting your spine to your rib.
- Poor posture. Drooping your shoulders or holding your head in a forward position can cause compression in the thoracic outlet area.
- Trauma. A traumatic event, such as a car accident, can cause internal changes that then compress the nerves in the thoracic outlet. The onset of symptoms related to a traumatic accident often is delayed.
What are the treatments for thoracic outlet syndrome (tos)?
Treatment of the thoracic outlet syndrome can usually be successful with conservative measures. Treatments include a variety of exercises that effectively stretch open the tissues of the thoracic outlet. These are done with and without weights in the hands to pull the outlet into a "relaxed" open position. Physical therapists are specially trained in the instruction of exercises for thoracic outlet syndrome, and their evaluation of the patient can be helpful. Shoulder-shrug exercises and others can be done at home or at work to relax the muscles around the thoracic outlet.
Patients should avoid prolonged positions with their arms held out or overhead. For example, it is best to avoid sleeping with the arm extended up behind the head. It is also helpful to have rest periods at work to minimize fatigue. Weight reduction can be helpful for obese patients. Patients should avoid sleeping on their stomach with their arms above the head. They should also not repetitively lift heavy objects.
A health-care professional might prescribe medications such as an anti-inflammatory medications (ibuprofen [Advil]) or muscle relaxants to help improve the symptoms.
Some patients with severe, resistant symptoms can require surgical operations to open the thoracic outlet. These procedures include interruption of the scalene muscle (scalenotomy) and removal (resection) of the first rib in order to spare injury to the affected nerve and blood vessels from ongoing compression. Thoracic outlet syndrome that affects the vascular system (veins and arteries) is more likely to require surgery to resolve the symptoms.
What are the risk factors for thoracic outlet syndrome (tos)?
There are several factors that seem to increase the risk of thoracic outlet syndrome, including:
- Sex. Females are greater than three times more likely to be diagnosed with thoracic outlet syndrome than are males.
- Age. Thoracic outlet syndrome may occur at any age but is most commonly diagnosed in adults between the ages of 20 and 50.
Is there a cure/medications for thoracic outlet syndrome (tos)?
Most people with thoracic outlet syndrome can have complete resolution of symptoms with conservative measures, including exercises specific for thoracic outlet syndrome, physical therapy, and avoiding stressing the tissues of the thoracic outlet. It can be helpful to avoid sleeping with the arms extended above the head. Rarely, surgical intervention can be necessary to take pressure off of involved nerves and blood vessels. Complications include embolization to the hand and nerve damage to the extremity involved.