THORACIC OUTLET SYNDROME
Just above your collar bone, between your shoulder, your first rib, and your lower neck, there is a “tunnel,” called the Thoracic Outlet, through which nerves, arteries, and blood vessels go, on their way to supply the arms. When this tunnel is made smaller, usually by injury, poor posture, or muscle tightness, there is increased pressure on the sensitive structures traveling through it. This creates a disorder known as thoracic outlet syndrome (TOS).
There are three main types of thoracic outlet syndrome, (caused by nerves, veins, or arteries) and all three forms cause pain in the neck and shoulder. Many people with TOS also get pain, and sometimes tingling or numbness going down their arm, and into their hand, especially into the ring and pinky fingers. If this disorder is left untreated, the pressure on the cardiovascular system caused by thoracic outlet syndrome can lead to blood clots, muscle atrophy, and even permanent nerve damage.
The 3 types of TOS:
Neurogenic
(coming from the nerves)
This is the most common form of TOS. It happens when the nerves coming out from the bottom of your neck are compressed. These are the patients who tend to respond well to conservative treatment. Symptoms of neurogenic TOS include:
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pain in the neck, shoulder, and arm
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headaches
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numbness, tingling, or weakness in the arm or hand (especially the ring & pinky fingers)
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arm or shoulder pain when reaching, lifting, throwing, or catching objects
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hand coldness and intolerance to cold
What are the risk factors of TOS?
TOS is a pretty rare condition, but your chances of developing TOS are increased by:
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poor posture
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obesity
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repetitive arm and shoulder movements, especially above your shoulders
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anatomical abnormalities
Those who play sports, or have jobs, that require repetitive overhead movements are more likely to suffer from TOS. Most sufferers are between 20 and 50 years old. Women are 3x as likely to develop TOS, and Pregnant women are at an even greater risk. If you have had a trauma or injury to their neck or upper back, you also have increased risk of developing TOS.
Some TOS cases can be caused by being born with an extra rib. These anatomical abnormalities can limit the space in the thoracic outlet and put pressure on your nerves and arteries.
Venous (coming from the veins)
This condition develops when the subclavian vein is compressed between the clavicle and first rib. A blood clot will form in the compressed vein, leading to arm swelling, discoloration, numbness, and pain. This syndrome is also known as Paget-Schroetter disease. It’s not as common as neurogenic TOS, but it is one of the most common vascular disorders in competitive athletes and should be treated swiftly to avoid worsening symptoms.
Arterial (coming from the arteries)
This is the rarest form of TOS, affecting only about 5% of all patients with TOS. Arterial TOS happens when the subclavian artery is compressed. This can lead to aneurysms and blood clotting. Symptoms of arterial TOS include:
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hand pain
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coldness, paleness, and tingling sensations in the hand
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chronic arm weakness and cramping when in use
The 3 types of TOS have similar symptoms, and that is why getting the proper diagnosis can lead to more treatment recommendations, fewer complications, and faster recovery.
Traditional treatment for TOS
Traditionally, your doctor may order various imaging and nerve study tests to help determine the cause of pain and rule out other conditions.
Most cases of TOS can be resolved with conservative treatment. Initially your doctor may recommend physical or occupational therapy to correct your posture and strengthen your muscles.
Over-the-counter pain medications and muscle relaxers may be prescribed for pain relief, while thrombolytic and anticoagulant medications might be prescribed to help dissolve and prevent blood clots.
Surgery is often recommended if an anatomical abnormality is the cause or if conservative treatments don’t resolve the condition. Physical therapy may be used before and after surgery to aid in your recovery.
Although physical therapy can be an effective form of conservative treatment for many, the strengthening and recovery process can take months, and the costs can quickly add up. Surgery requires extensive recovery time, rendering you unable to do many of the activities you love. It can also be too costly, both financially and in health, with high costs and risks for potential complications.
