It is a disorder occurring due to the compression of blood vessels and nerves. Read this article to know more about the symptoms, causes, and treatment.
The thoracic outlet mentions the space between your clavicle and your first rib bone. This narrow passageway of the thoracic outlet is populated with blood vessels, nerves, and other muscles. The neurovascular bundle comprises the thoracic outlet subclavian vein, subclavian artery, and brachial nerve plexus.
The term Thoracic outlet syndrome refers to a group of disorder. It occurs when there is an injury, compression, and irritation to the nerves and blood vessels. The pain will be felt in the shoulders, neck, and tingling sensation in the fingers. Thoracic outlet syndrome is named after the space between your neck and upper chest. There will be a grouping of nerves and blood vessels.
Neurogenic Type: Neurogenic thoracic outlet syndrome occurs when the nerves leading from the neck is getting compressed. Most of the cases come under this type.
Venous Type: This type occurs when a vein is compressed. This leads to upper body thrombosis. A minor percentage of people come under this type.
Arterial Type: This type occurs when an artery is compressed. It is also known to occur in a few people.
Thoracic outlet syndrome affects the athletes, gymnastics people, and others who are too much involved in sports.
The neurogenic type being the common form, can affect the middle-aged women.
Thoracic outlet syndrome can be due to different factors. They are:
Trauma such as whiplash injury, car accidents, etc.,
Strain. This can be seen more in swimmers and volleyball players.
Rare tumors such as osteomyelitis.
Poor posture. The collarbones can slip out of place and cause pressure on the nerves. Drooping of the shoulders might be seen in such conditions.
Pregnancy: Loosening of muscles might occur during pregnancy.
Physical defects: Few people have an extra rib by birth.
Obesity: Excess of weight can put more stress on the muscles that are known to support the collar bone.
Repeated activities. This might include typing in the computer, lifting heavy objects, etc.,
The symptoms of thoracic outlet syndrome vary according to the types.
Pain in the shoulder and arms.
Tingling sensation in the fingers.
Discomfort in the fingers.
Edema in the arms, hand, and fingers.
The hand and arm changes to a bluish color.
Tingling sensation in the hands.
Veins become more prominent in the shoulder, neck, and hands.
There might be coldness, numbness, and pain in the arms and hands.
This might cause a whitish appearance in the hands.
You should consult a doctor if you experience any symptoms of thoracic outlet syndrome. You should provide more care if it lasts for several weeks. Before the worsening of symptoms, contact a doctor immediately.
For diagnosis, your doctor will perform a physical exam. The medical history of the patient might be necessary. Provocation tests can be used to evaluate the condition. These tests are meant to replicate the symptoms you are facing so that your doctor can make a faster and easier diagnosis. Your doctor will ask you to physically move your neck, shoulders, and arms. This will be asked to do in different positions.
Your doctor may ask you to perform an additional test in order to confirm the diagnosis.
An X-ray of the thoracic region can be a good diagnostic tool. It can reveal the presence of an extra rib.
Electromyography: It helps to locate the muscles and nerves in the thoracic outlet.
An MRI imaging technique uses powerful magnets and radio waves. This helps to make detailed images of the thoracic outlet. These pictures can determine the location and etiology of the compression. Any structural abnormalities can also be identified.
The treatment for thoracic outlet syndrome aims to relieve the symptoms and pain. Both medications and surgical options are available. In mild cases, medications can be helpful. But in severe cases, surgery might be required.
Treatment for thoracic outlet syndrome starts with medications. These medications can ease the symptoms. Over-the-counter medications, such as Naproxen and Ibuprofen, are available. This may be used to reduce inflammation and pain. Some of the Thrombolytic drugs are used to dissolve clots in veins or arteries. Anti-coagulants can also be used.
Ideal methods of physical therapy are recommended. This helps to strengthen the shoulder muscles. Physical therapy exercises reduce the pressure in blood vessels and nerves. Your doctor may recommend you for a weight-loss program if you are overweight. Excess body weight can increase the pressure on the joints. Go to the gym and follow a weight loss regime. Before trying out an exercise, it is necessary to ask your doctor for modifications in the exercises according to your physical conditions.
You may be in need of surgery if your symptoms do not improve with the initial form of treatment, such as medication and physical therapy. Surgical procedures for thoracic outlet syndrome involves removing an extra rib from the set of rib bones. Rerouting of blood vessels can also be done. Angioplasty can be done to inflate the narrowed vessels.
Thoracic outlet syndrome, if left untreated for many years, can cause permanent neurological damage. It is important to check your symptoms early so that treatment can be started as soon as possible. Avoid repetitive movements if you have a doubt of falling to thoracic outlet compression. Lifting heavy objects should also be avoided. If you have a high BMI, perform appropriate exercises. Even if you do not have symptoms of thoracic outlet syndrome, do not carry heavy bags over the shoulder. Stretch your body daily. Perform exercises that will keep your shoulder muscles thoracic outlet syndrome.
If you are facing any symptoms, call a doctor online, or make a video call to discuss your health condition.
Thoracic outlet syndrome (TOS) is a combination of various conditions that can pressure the arteries, veins, and nerves in a person's upper chest. This condition can cause pain, cold sensation, and numbness in arms and hands. Thoracic outlet syndrome is not a life-threatening condition. However, it may lead to complications if left untreated.
Thoracic outlet syndrome is broadly classified into three major types. They are as follows:
- Neurogenic type of thoracic outlet syndrome, which chiefly occurs when the nerves present between the neck and the arms are compressed.
- Venous type of thoracic outlet syndrome occurs when a vein in the thoracic region is compressed. The complication that arises from this type is upper body thrombosis.
- Arterial type of thoracic outlet syndrome which occurs when an artery of the thorax is compressed.
The primary tools of diagnosing a thoracic outlet syndrome is a detailed and thorough history and physical examination. Additional tests and imaging studies are also required to confirm the diagnosis of thoracic outlet syndrome. The primary imaging modality is an X-ray that can reveal the presence of an extra cervical rib. X-rays also serve as a tool to rule out other conditions.
The following includes the list of common causes that can cause a thoracic outlet syndrome:
- Physical trauma from a vehicular accident.
- Repetitive injuries from activities related to the job or sports.
- Anatomical defects since birth, such as having an extra cervical rib.
Thoracic pain usually increases with certain positions or movements of the neck region. The pain can be sharp or dull in character. The pain can also be noted to radiate around one or both sides of the rib cage. This pain is usually triggered by physical exercises. It can be caused while taking a deep breath.
If you are diagnosed with thoracic outlet syndrome, a change in sleep positions can help relieve your symptoms. Instead of sleeping in a flat position, you are advised to try sleeping on one side of your body. You can even sleep without a firm pillow.
A person's recovery time primarily depends on age, cause, type of treatment, and other complications. The definitive treatment is surgery. The regular hospital stay after a thoracic outlet syndrome surgery is two to three days. After leaving the hospital, patients can usually return to their normal daily routine but are advised not to lift anything that is heavier than 10 pounds for at least four weeks.
If patients are diagnosed with thoracic outlet syndrome, physical therapy is the first line of treatment. In this modality of treatment, patients will learn how to do exercises that strengthen and stretch their shoulder muscles to open the thoracic outlet.
Thoracic outlet syndrome, which is especially symptomatic, requires proper treatment. In cases where it is left untreated, thoracic outlet syndrome can lead to the development of neck and shoulder pain, numbness and tingling of the fingers, and a weak grip. Thoracic outlet syndrome can also cause increased pain, decreased function, and even serious blood clots.
Yes, the application of heat at the thoracic outlet may relieve nerve and muscle compression in that region. This can alleviate the pain and swelling present in that region. It is important to note that heat is only a relieving factor and not the definitive treatment.
Yes, thoracic outlet syndrome can make you feel tired. The common symptoms seen in people affected by this condition are pain, numbness, tingling, or weakness in his or her arm and hand. All these symptoms can act as a combined factor in making you tired.
Thoracic outlet syndrome most commonly involves all the fingers, but it is most noticeable in the fourth and fifth fingers and also at the ulnar forearm. These fingers can have weakness and cold intolerance.
Patients with asymptomatic thoracic outlet syndrome are usually given physical therapy only. But in patients affected with arterial thoracic outlet syndrome, surgical correction of the condition is needed. Surgery might be performed in a way to remove the first rib. This can make more space for the vessels and nerves and relieve the compression. Surgery can also be helpful in repairing any structural problems of the artery.
The following are various factors that can aggravate the thoracic outlet syndrome:
- Anatomical defects.
- Poor posture.
- Physical trauma.
- Repetitive activity.
- Pressure on the person's joints.
Thoracic outlet syndrome that is left untreated for years can lead to permanent neurological damage. So when a person is diagnosed with thoracic outlet syndrome, it is important to have his or her symptoms evaluated and treated early. This can prevent the condition from getting complicated. If a person has thoracic outlet compression, he or she should avoid repetitive movements and also should resist from lifting heavy objects.
In mild cases, physical therapy can give a definitive cure. In severe cases, surgical correction can be made. But in people who have left the condition untreated for several years and have developed complications already, it is difficult to completely cure thoracic outlet syndrome.
Scalene stretch is the most commonly recommended exercise for people affected by thoracic outlet. These set of exercises are proven to improve thoracic outlet syndrome significantly.
Last reviewed at:
10 Sep 2020 - 4 min read
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