Overview
Thoracic outlet syndrome (TOS) is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause shoulder and neck pain, as well as numbness in your fingers. The three main types of thoracic outlet syndrome are neurogenic (neurologic), venous, and arterial. Common causes include physical trauma, repetitive injuries from job or sports activities, certain anatomical defects, and pregnancy. Treatment typically involves physical therapy and pain relief measures, but surgery may be recommended in some cases. If you experience signs and symptoms of thoracic outlet syndrome, it is important to seek medical attention for appropriate evaluation and treatment.
Understanding the disease
Symptoms
The symptoms of thoracic outlet syndrome can vary depending on the type. Here are the symptoms for each type: Neurogenic (neurologic) thoracic outlet syndrome:
- Numbness or tingling in your arm or fingers
- Pain or aches in your neck, shoulder, arm or hand
- Weakening grip Venous thoracic outlet syndrome:
- 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 Arterial thoracic outlet syndrome:
- 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 It's important to note that symptoms can vary, and a person may experience a mix of symptoms from different types of thoracic outlet syndrome. If you're experiencing any of these symptoms, it's important to seek medical attention for a proper evaluation and diagnosis.
Risk Factors
Risk factors for developing thoracic outlet syndrome include being female (as females are more than three times more likely to be diagnosed than males), age (the condition is most commonly diagnosed in adults between 20 and 50 years old), and engaging in activities that involve repetitive movements or lifting heavy objects. Additionally, having certain anatomical defects, such as an extra rib, or experiencing physical trauma from a car accident can increase the risk of developing thoracic outlet syndrome.
Development
Thoracic outlet syndrome (TOS) develops when there is compression of the blood vessels or nerves in the space between the collarbone and the first rib. This compression can occur for different reasons, leading to the three types of TOS: neurogenic, venous, and arterial.
- Neurogenic (neurologic) thoracic outlet syndrome: This is the most common type of TOS, characterized by the compression of the brachial plexus, a network of nerves that control muscle movements and sensation in the shoulder, arm, and hand.
- Venous thoracic outlet syndrome: In this type of TOS, one or more of the veins under the collarbone are compressed, resulting in blood clots.
- Arterial thoracic outlet syndrome: The least common type of TOS, it occurs when one of the arteries under the collarbone is compressed, resulting in an aneurysm (bulging of the artery). These types of TOS can occur individually or combine in cases where multiple parts of the thoracic outlet are compressed. The development of TOS can be due to physical trauma, repetitive injuries, anatomical defects, pregnancy, or poor posture. Additionally, risk factors such as being female, being between the ages of 20 and 50, or having a history of trauma increase the likelihood of developing TOS.
Assessment and Diagnosis
Triage
You should see a doctor if thoracic outlet syndrome is suspected, particularly if you have any of the following symptoms:
- Neurogenic thoracic outlet syndrome: Numbness or tingling in your arm or fingers, pain or aches in your neck, shoulder, arm, or hand, weakening grip.
- Venous thoracic outlet syndrome: 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.
- Arterial thoracic outlet syndrome: 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. If you experience any of these symptoms, it's important to seek medical attention with appropriate evaluation and testing to determine the appropriate course of treatment.
Diagnosis
To diagnose thoracic outlet syndrome, your doctor may review your symptoms and medical history, conduct a physical examination, and order additional imaging and testing. The physical examination may include checking for external signs of the disorder, such as a depression in your shoulder, a bony abnormality above the collarbone, or abnormal pulses. Your doctor may also test range of motion and try to reproduce your symptoms by asking you to move or lift your arms. Imaging tests, such as ultrasound or X-ray, may be ordered to help confirm the diagnosis.
Management and Treatment
Complications
Complications from thoracic outlet syndrome stem from the type of presentation, which can be neurogenic, venous, or arterial. For patients with venous or arterial TOS, it is crucial to seek urgent medical attention to make the correct diagnosis and implement appropriate treatment. For neurogenic TOS, it is important to seek medical attention with appropriate evaluation and testing.
Prevention
There are preventive measures you can take to reduce the risk of developing thoracic outlet syndrome. These include:
- Avoiding repetitive movements: Minimizing repetitive shoulder motions and lifting heavy objects can help prevent compression in the thoracic outlet area.
- Maintaining good posture: Keeping your shoulders back and head held high can help reduce pressure on the nerves and blood vessels in the thoracic outlet.
- Exercising regularly: Engaging in daily stretching and strengthening exercises for your shoulder muscles can help maintain proper alignment and reduce the risk of thoracic outlet syndrome.
- Managing weight: If you are overweight, losing weight may help prevent or relieve symptoms of thoracic outlet syndrome by reducing pressure on the thoracic outlet area.
- Seeking prompt medical attention: If you experience symptoms of thoracic outlet syndrome or have been involved in a traumatic event, seeking prompt medical attention can help ensure proper evaluation and treatment to prevent complications.
Treatment
Treatments for thoracic outlet syndrome typically involve a combination of physical therapy, pain relief measures, and, in some cases, surgery.
- Physical therapy: A physical therapist can help you with exercises to strengthen the muscles in your neck, shoulders, and arms. This can help relieve pressure on the nerves and blood vessels in the thoracic outlet. Additionally, they can provide guidance on proper posture and body mechanics to prevent further compression.
- Pain relief measures: Over-the-counter pain relievers like ibuprofen or acetaminophen may help alleviate pain associated with thoracic outlet syndrome. Heat or cold packs can also be applied to the affected area to relieve pain or inflammation. In some cases, your doctor may prescribe a more potent pain medication.
- Surgery: In severe cases or when other treatments are ineffective, surgery may be recommended to relieve compression in the thoracic outlet. Surgical options include decompression procedures to release the compressed nerves or blood vessels or the removal of anatomical abnormalities causing the compression. However, surgery carries risks and is usually considered a last resort. It is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to your specific condition.
Preparing for medical consultation
To prepare for an appointment for thoracic outlet syndrome, follow these steps:
- Make a list of all your symptoms and when they began.
- List any other medical conditions you're being treated for and the names of any prescription and over-the-counter medications or supplements you're taking.
- Bring a family member or friend along to your appointment, if possible. They may remember something that you missed or forgot.
- Write down questions to ask your doctor. Some questions to consider asking include:
- What's the most likely cause of my symptoms?
- What tests do I need?
- What treatments are available, and which treatment do you recommend for me?
- How likely are nonsurgical treatments to improve my symptoms?
- If conservative treatments aren't effective, is surgery an option?
- Is there anything I can do to prevent a recurrence of this problem?
- Will I need to change my job?
- Do I need to limit or give up other activities that may be causing my symptoms?
- Be prepared to discuss your medical history, occupation, and physical activities with your doctor.
- Make a note of any positions or movements that trigger or worsen your symptoms.
- Consider trying self-care measures like gently massaging your shoulders and thoracic outlet, applying a heating pad, practicing relaxation exercises, and engaging in gentle stretching. Remember to be open and honest with your doctor about your symptoms and concerns. This information will help your doctor make an accurate diagnosis and recommend the most appropriate treatment plan.