Thoracic outlet syndrome refers to a group of conditions that develop when the blood vessels or nerves in the thoracic outlet become compressed.
The thoracic outlet is the narrow space between your collarbone and first rib. Blood vessels, nerves, and muscles that extend from the back to the arms pass through this area. If the space in the thoracic outlet is too narrow, these structures can become compressed.
The increased pressure on the blood vessels and nerves may cause pain in your shoulders, neck, and arms. It can also cause numbness or tingling in your hands.
What are the types of thoracic outlet syndrome?
Neurogenic TOS occurs when the nerves leading from the neck to the arm (the brachial plexus) are compressed. More than 90 percent of cases are neurogenic.
Venous TOS occurs when a vein is compressed, leading to upper body thrombosis. Five percent of cases are venous.
Arterial TOS occurs when an artery is compressed. Only about 1 percent of cases are arterial.
What are the symptoms of thoracic outlet syndrome?
The symptoms that you experience as a result of thoracic outlet syndrome will depend on whether the nerves or the blood vessels are affected.
Compressed nerves can cause:
Pain in parts of the neck, shoulder, arm, or hand
Numbness in the forearm and fingers
Weakness of the hand
Compressed blood vessels can cause:
Swelling of the arm
Redness of the arm
Hands or arms that feel cold to the touch
Hands or arms that become easily fatigued
You may also find it difficult to lift objects above your head. You might also have a limited range of motion in your shoulders and arms.
What causes thoracic outlet syndrome?
The cause of this compression isn’t always known. However, it may develop as a result of the following conditions:
An extra rib
Some people are born with an extra rib above their first rib. This reduces the size of their thoracic outlet and compresses nerves and blood vessels.
Poor posture and obesity
People who don’t stand up straight or who have excess abdominal fat may have increased pressure on their joints. This can cause a narrowing of the thoracic outlet.
Injury
Car accidents and other traumatic injuries can compress the thoracic outlet as well as the vessels and nerves in this area.
Overuse of the shoulders and arms
Repetitive activities, such as working at a computer or lifting heavy objects above the head, can cause damage to the tissues in the thoracic outlet. Over time, the size of the thoracic outlet may shrink, placing pressure on the vessels and nerves.
How is thoracic outlet syndrome treated?.
Physical therapy is typically the first treatment.
Injections are sometimes effective when physical therapy doesn’t completely relieve symptoms.
If symptoms persist after physical therapy and injections, surgery may be recommended. Surgery can involve cutting small muscles of the neck (anterior and middle scalene) and removing the cervical or first rib.
How can thoracic outlet syndrome be prevented?
It may not be possible to prevent thoracic outlet syndrome. If the condition develops, you can take steps to reduce symptoms and to prevent it from recurring.
Practicing proper posture when sitting or standing
Taking breaks at work or school to stretch and move around
Maintaining a healthy weight
Performing strengthening exercises
Avoiding activities that make your symptoms worse
Avoiding lifting heavy objects
Avoiding carrying heavy bags on the shoulders
Avoiding making repetitive movements
References
https://www.hopkinsmedicine.org/health/conditions-and-diseases/thoracic-outlet-syndrome
https://rarediseases.org/rare-diseases/thoracic-outlet-syndrome/
Dasith Gamage
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