Thoracic Outlet Syndrome

What is Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome, sometimes referred to as TOS or Thoracic Outlet Compression, is a general term used to describe a group of disorders that cause pain in the neck and upper chest area due to compression of the veins, arteries and nerves located in the thoracic outlet.

What is the Thoracic Outlet?

The thoracic outlet is that hollow-seeming area between your collar bone and your first rib. Anatomically, it’s basically the loop made by the clavicle and the first rib. The Subclavian blood vessels and muscle, the Anterior and Middle Scalene muscles, and the Brachial nerve all work together in this area, running down your neck, through the thoracic outlet “loop” and then out towards your shoulder and down your arm. When any of these arteries, veins or nerves become compressed or irritated by movement of the clavicle or inflammation of the surrounding muscles, you can experience pain, weakness in the arm or neck, and/or a limit in movement and comfort in the associated areas.

Causes of Thoracic Outlet Syndrome

TOS is an often either a trauma-related syndrome (meaning caused by an acute event such as a car accident) or a repetitive movement injury (meaning caused by long-term overuse of the shoulder and arm, such as in sports or constantly carrying a backpack). Basically, any event, activity or physical abnormality that can cause your collarbone to move around more than it should or irritates your shoulder muscles can put you at risk for TOS. Some common causes are:

  • Injury to the first rib or collarbone, usually resulting from a traumatic event.
  • Any anatomical flaws in the area, such as being born with an extra rib or poorly/incorrectly formed Scalene muscles. Anatomical defects exist from birth.
  • Poor posture, which can cause the space between the collarbone and the first rib to flatten.
  • Pregnancy, as a result of the natural loosening of joints as the body prepares to accommodate a growing fetus.
  • On rare occasions, compression in this area can be caused by a tumor.
  • Obesity, which can cause undue stress on this area because of extra fat in the neck.
  • Bodybuilding/weightlifting can also cause TOS, as you can work your neck muscles into being so large that they compress this area around the affected blood vessels and nerves.
  • Fascia tightening bringing the first rib and clavicle closer together. This is the main cause. It can happen from injury, posture, pregnancy, and obesity as above.

There are many causes of TOS, and sometimes the cause is not able to be identified. But even if you’re not sure how this discomfort in your shoulder and arm began, you can probably decipher it’s TOS by comparing your symptoms to the common symptoms of this disorder.

Common Symptoms of Thoracic Outlet Syndrome

Three types of TOS exist, and each present their own specific set of symptoms. However, medical professionals disagree on the exact identification and even existence of certain types of TOS. But all share some common symptoms to look out for:

  • Cold, pale, numb or tingly hands and arms
  • Pain in the neck and shoulder
  • Weak pulse in the arm on the affected side
  • Unusual arm fatigue during exercise or activity
  • Weakness, pain or inability to raise your arm above your head
  • Bulging veins in the neck or shoulders
  • Swelling of the arm or shoulder, which can even include a lump in the Thoracic Outlet
  • Rare: atrophy of muscles in the thumb and palm of the affected arm

If you are experiencing any of these symptoms, it’s important to consult a doctor immediately, as TOS is a treatable condition, but if left untreated too long, it has the potential to cause permanent nerve damage.

What are the Treatments for TOS?

Because of the intricacies of TOS, as well as the affected area being a part of your body you can never fully rest (we need our arms and shoulders to do basic movements), Thoracic Outlet Syndrome is best treated with a holistic approach. If treated properly, patients often recover within a few weeks. However, before beginning any treatment, your doctor should evaluate your medical history as well as rule out any other possible neurogenic causes for the pain. Once your doctor has ruled out any other causes, their recommendation for treatment may include:

  • Exercises to relax and stretch the fascia in this area.
  • Food changes to decrease fascia tightening and inflammation.
  • Physical therapy: This is the most often used treatment for TOS because it is mitigative as well as preventative. Physical therapy will increase your range of motion as well as strengthen the muscles in the affected area. And if your therapist can release the tightened fascia the issue may resolve.
  • Medication: OTC medications like Tylenol can lessen the pain. Your doctor may also recommend blood thinners to prevent the risk of blood clots forming in the compressed arteries and veins. A medication regiment will most often be partnered with a period of rest and limiting movement of the affected area.
  • Weight loss: If you’re overweight, eliminating extra fat from the area will lessen compression.
  • Changing daily habits: Try to avoid movements and postures you know exacerbate your symptoms, such as crouching over a laptop or playing basketball.

Surgery for TOS is often a last resort if the above listed treatments have failed to lessen the pain and discomfort. Surgical intervention is most common in the types of TOS that are caused by physical/congenital abnormalities, because there is really nothing you can do to prevent TOS if the structures in the Thoracic Outlet area itself are malformed. Surgical intervention can include removal of the top rib and/or releasing one of the Scalene muscles affecting the ability of the arteries and nerves to function without difficulty. If a patient’s case of TOS included blood clots forming in the affected arteries and veins, the surgeon may also replace the damaged portion of the damaged blood vessel.

Preventing TOS from Recurring

Best practices for preventing Thoracic Outlet Syndrome from reoccurring include becoming mindful of the movements you make, continuing any exercises your physical therapy included, and avoiding putting any undue stress on the affected area. TOS is a syndrome where, even after it’s treated, you will always be more prone afterwards to suffering from it again. This is another reason to seek medical intervention as soon as possible so you lessen your risk for dangerous blood clots or permanent nerve damage.

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