Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) is when you have swelling, pain or other symptoms from compression in your thoracic outlet, which is the opening between your lower neck and upper chest.  It can cause tingling and numbness in your shoulders, especially when you raise your arms.

The thoracic outlet is the narrow space between your collarbone and top ribs.  Muscles run through it from your neck to your shoulder, along with the nerves and blood vessels that go down your arm.  When something presses on them, you can have pain and other symptoms.

Types of Thoracic Syndrome Types

• Neurogenic.  Affects nerves leading from the spinal cord to the neck to the arm.  Most thoracic outlet syndrome cases involve nerves.
• Arterial.  Affects the arteries
• Venous.  Affects the veins

The condition is more common in women.  It also often seen in athletes and workers who make repeated arm motions.  But it can affect anyone.

Symptoms of Thoracic Outlet Syndrome

• Pain in the neck, shoulder or arm
• Swelling
• Weakness
• Tingling and numbness
• Cold hands
• Discoloration – red, blue or pale colors
• Atrophy (when the muscle or tissue in your arms start to waste away)
• Painful lump near your collarbone
• Weak pulse in your affected arm
• Gilliatt-Sumner hand which is the shrinking of the muscle in the fleshy base of your thumb

Risk factors and causes of Thoracic Outlet Syndrome

• Injuries such as whiplash or broken collarbone, or an injury that can leave scar tissue and inflammation.
• Repetitive stress can affect people who move their arms in a particular way over and over.
• Poor posture.   Slumping can cause your collarbone to move out of place and press on your nerves.  Weak shoulder muscles can cause bad posture.
• Sleep disorders
• Obesity can put extra weight on your muscles.
• Depression or stress

When Thoracic Outlet Syndrome is diagnosed, your doctor may begin by asking questions about the history of your symptoms followed by a physical exam.  Imaging tests such as an X—ray, CT Scan, MRI or an Ultrasound can detect an abnormal physical feature or a possible blockage or narrowing of blood vessels. Depending on the type of Thoracic Outlet Syndrome, treatments may include medication such as ibuprofen or naproxen, Botox shots, and sometimes surgery.

Thoracic Outlet Syndrome should be treated as soon as possible.  If it’s not, it can lead to more serious issues such as nerve damage, blood clots, and blood flow problems.