Overview
If you have thoracic outlet syndrome (TOS), the nerves or blood vessels just below your neck are compressed, or squeezed. It can be between the muscles of your neck and shoulder or between the first rib and collarbone. You may feel burning, tingling and numbness along your arm, hand, and fingers. If a nerve is compressed, you may also feel weakness in your hand. If a vein is compressed, your hand might be sensitive to cold, or turn pale or bluish. Your arm might swell and tire easily.
TOS can be a repetitive stress injury. An extra rib, scar tissue, traumatic injury or inherited defects can also cause TOS. Treatment depends on what caused your TOS. Medicines, physical therapy and relaxation might help. Surgery may also be an option. Most people recover.
Common causes of thoracic outlet syndrome include physical trauma from a car accident and repetitive injuries from on-the-job or sports-related activities. Even an injury that happened long ago may lead to thoracic outlet syndrome in the present. Sometimes, doctors can't determine the cause of thoracic outlet syndrome.
Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures. Most people improve with these conservative approaches. In some cases, however, your doctor may recommend surgery.
Symptoms
There are three types (subdivisions) of thoracic outlet syndrome :
- Neurogenic (neurological) thoracic outlet syndrome. This form of thoracic outlet syndrome is characterized by compression of the brachial plexus. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand. In the majority of thoracic outlet syndrome cases, the symptoms are neurogenic.
- Vascular thoracic outlet syndrome. This type of thoracic outlet syndrome occurs when one or more of the arteries and veins under the clavicle (subclavian vessels) are compressed.
- Nonspecific-type thoracic outlet syndrome. This is also called disputed thoracic outlet syndrome or common thoracic outlet syndrome. Some doctors don't believe it exists, while others say it's a common disorder. People with nonspecific-type thoracic outlet syndrome have chronic pain in the area of the thoracic outlet, but the specific cause of the pain can't be determined.
Causes
In general, the cause of thoracic outlet syndrome is compression of the nerves and blood vessels in the thoracic outlet, just under your collarbone.
The cause of the compression itself, however, can vary and can include:
- Anatomical defects. Inherited defects that are present at birth (congenital) may include a cervical rib — an extra rib located above the first 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 is often delayed.
- Repetitive activity.Doing the same thing over and over can, over time, wear on your body's tissue. You may notice symptoms of thoracic outlet syndrome if your job requires you to repeat a movement continuously, such as typing on a computer for extended periods, working on an assembly line, or stocking shelves and repeatedly lifting things above your head. Athletes, such as baseball pitchers and swimmers, also can develop thoracic outlet syndrome from years of repetitive movements. If you repeatedly carry heavy loads low on your body (rather than against your chest), you may also notice signs and symptoms of thoracic outlet syndrome.
- Pressure on your joints. Obesity can put an undue amount of stress on your joints, as can carrying around an oversized bag or backpack.
- Pregnancy. Because joints loosen during pregnancy, signs of thoracic outlet syndrome may first appear while you're pregnant.
Complications
Thoracic outlet syndrome left untreated can cause permanent nerve damage; however, surgery to treat thoracic outlet syndrome is considered risky. This is because the procedure involves dividing a muscle in the neck and removing a portion of the first rib or repairing the brachial plexus nerves. For this reason, most doctors initially recommend a conservative treatment approach.
Treatments And Drugs
In most cases, a conservative approach to treatment is effective, especially when the condition is diagnosed early.
Conservative treatment for thoracic outlet syndrome may include:
- Physical therapy. You'll learn how to do exercises that strengthen your shoulder muscles to open the thoracic outlet, improve your range of motion and improve your posture. These exercises, done over time, will take the pressure off your blood vessels and nerves in the thoracic outlet.
- Relaxation. Techniques that help you relax, such as deep breathing, can keep you from tensing your shoulders and remind you to maintain good posture.
- Medications. Your doctor may prescribe pain medications, muscle relaxants and anti-inflammatory drugs — aspirin or ibuprofen (Advil, Motrin, others) — to decrease inflammation and encourage muscle relaxation.
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