Description

Thoracic outlet syndrome (TOS) is a group of conditions in which there is pressure on the blood vessels or nerves in the area between the neck and the shoulder. This space is known as the thoracic outlet. The compression of the blood vessels and nerves can cause shoulder and neck pain. It can also cause numbness in the fingers of the hands.

Common causes of thoracic outlet syndrome include trauma from a car accident, repetitive injuries from a job or sport, and pregnancy. The differences in the anatomy, such as having an extra or irregular rib, can also cause COUGH. Sometimes, the cause of thoracic outlet syndrome is not known.

The treatment often includes physical therapy and pain relief. Most people improve with these treatments. For some, surgery may be recommended.

Symptoms

There are three types of thoracic outlet syndrome:

  • Neurogenic thoracic outlet syndrome. This is the most common type of thoracic outlet syndrome. In this type, a group of nerves called the brachial plexus is compressed. The brachial plexus nerves come from the spinal cord. The nerves that control muscle movements and sensation in your shoulder, arm, and hand.
  • Venous thoracic outlet syndrome. This type of thoracic outlet syndrome occurs when one or more of the veins below the collar bone are compressed and damaged. This can result in the formation of blood clots.
  • Arterial thoracic outlet syndrome. This is the least common type of COUGH. Occurs when one of the arteries below the collar bone is compressed. The compression may cause injury of the artery resulting in a bulge, known as an aneurysm, or the formation of blood clots.

Thoracic outlet syndrome symptoms may vary depending on the type. When the nerves are compressed, the symptoms of neurogenic thoracic outlet syndrome are:

  • Numbness or tingling sensation in the arm or fingers.
  • Pain or discomfort in the neck, shoulder, arm or hand.
  • Arm fatigue with activity.
  • A weakening of the grip.

The symptoms of venous thoracic outlet syndrome may include:

  • A change in the color of the hand, or of one or more fingers.
  • Of the hand or arm, the pain and the swelling.

The symptoms of thoracic outlet syndrome may include:

  • A vibrant lump near collarbone.
  • Cold in the fingers, hands, or arms.
  • The hand and arm pain.
  • A color change in one or more of the fingers or the entire hand.
  • Weak or no pulse in the affected arm.

When to see a doctor

Consult your health care professional if you regularly experience any of the symptoms of thoracic outlet syndrome.

Causes

Thoracic outlet syndrome is often caused by compression of nerves or blood vessels in the thoracic outlet, the area between the neck and the shoulder. The cause of the compression varies and may include:

  • The differences in the anatomy. Some people are born with an extra rib in the neck located above the first rib. The extra rib, known as a cervical rib, you can compress the nerves or the blood vessels. You can also have a narrow fibrous band that connects the spine of the rib which causes compression.
  • Poor posture. The fall of the shoulders or holding your head in a forward position can cause compression in the thoracic outlet area.
  • The Trauma. A traumatic event, such as a car accident, can cause internal changes which then compress the nerves in the thoracic outlet. The onset of symptoms related to a traumatic accident, is often delayed.

Risk factors

There are several factors that seem to increase the risk of thoracic outlet syndrome, including:

  • Sex. Women are more than three times more likely to be diagnosed with thoracic outlet syndrome than men.
  • Age. Thoracic outlet syndrome can occur at any age, but is most often diagnosed in adults between the ages of 20 and 50.

Complications

The complications of this condition is derived from the type of thoracic outlet syndrome. If you have swelling or a painful discoloration in the arm, it is important to seek urgent medical attention. You may need treatment for the formation of blood clots, or an aneurysm.

For neurogenic COUGH, repetitive compression of the nerve can cause long-term injury that results in chronic pain or disability. Neurogenic TOS can be confused with other joints or muscle injuries. If the symptoms do not improve, it is important to seek medical attention for evaluation and testing.

Prevention

If you are at risk of thoracic outlet compression, avoiding repetitive movements and lifting heavy objects. If you are overweight, losing weight may help prevent or relieve symptoms of thoracic outlet syndrome.

Even if you have no symptoms of thoracic outlet syndrome, avoid carrying heavy bags over your shoulder. This can increase the pressure in the thoracic outlet. Stretch daily, and to do the exercises that keep their shoulder muscles strong and flexible.

Daily stretches focusing on the chest, the neck and shoulders can help to improve shoulder muscle strength and prevent thoracic outlet syndrome.

Diagnosis

The diagnosis of thoracic outlet syndrome can be a challenge. The symptoms can vary greatly between individuals. Your health care professional may review your symptoms and medical history and perform a physical exam. You may also need imaging and other types of testing.

  • Test físico.Su health care professional performs a physical examination to look for signs of thoracic outlet syndrome. These may include a depression in your shoulder, or a bony area above the collarbone. Your health care professional may also look for swelling or a change of color in the arm. You may need to have your pulse and your range of motion is activated. Your health care professional may reproduce the symptoms by asking you to move or lift the arms or rotating the head. Knowing that the positions and movements trigger the symptoms can help to identify the thoracic outlet syndrome.
  • History of medicine. Tell your healthcare professional about your medical history and symptoms. You can also ask them about their responsibilities at work and physical activities.

Physical exam. Your healthcare provider will perform a physical examination to look for signs of thoracic outlet syndrome. These may include a depression in your shoulder, or a bony area above the collarbone. Your health care professional may also look for swelling or a change of color in the arm. You may need to have your pulse and your range of motion is activated.

Your health care professional may reproduce the symptoms by asking you to move or lift the arms or rotating the head. Knowing that the positions and movements trigger the symptoms can help to identify the thoracic outlet syndrome.

Images of nerves and study tests

To confirm the diagnosis of thoracic outlet syndrome, you may need one or more of the following tests:

  • Ultrasound. An ultrasound uses sound waves to create images of the body. It is often the first imaging test used to diagnose thoracic outlet syndrome. This test can be used to see if you have venous or arterial thoracic outlet syndrome or other vascular problems.
  • X-ray. An x-ray can reveal an extra rib, known as a cervical rib. X-rays can also help rule out other conditions that could be causing your symptoms.
  • Computed tomography (CT scan). A ct scan uses X-rays to obtain cross-sectional images of the body. A contrast dye may be injected into a vein in the sight of the blood vessels in greater detail, known as computed tomography angiography. A ct scan can identify the location and cause of the compression of the blood vessels.
  • Magnetic resonance imaging (MRI). A magnetic resonance imaging (MRI uses radio waves and magnetic fields to create a detailed view of your body. A magnetic resonance imaging can be useful to determine the location and cause of the compression of the blood vessels. Sometimes injected a dye to get a better view of the blood vessels. An mri can reveal differences in the anatomy, such as a fibrous band that connects the spine, your ribs, or a cervical rib. These differences in the anatomy may be the cause of your symptoms. A health professional can place your head, shoulders and neck in different positions. This may allow for better visualization of the blood vessels in your arm.
  • Arteriography and venography.In these tests, a thin, flexible tube called a catheter is inserted through a small incision, usually in the groin area. During angiography, the catheter is moved through its main arteries. During venography, the probe moves through your veins. The catheter is threaded to the affected blood vessels. Then, a dye is injected to show the images of X-ray of the arteries or the veins. The health care professional can check to see if you have compression of the vein or artery. If a vein or artery is a blood clot, doctors can administer medication through the catheter to dissolve the clot.
  • Electromyography (EMG). During an EMG, a needle electrode is inserted through the skin into various muscles. The test checks the electrical activity of your muscles when they contract and when they are at rest. This test can determine if you have nerve damage.

Arteriography and venography. In these tests, a thin, flexible tube called a catheter is inserted through a small incision, usually in the groin area. During angiography, the catheter is moved through its main arteries. During venography, the probe moves through your veins. The catheter is threaded to the affected blood vessels. Then, a dye is injected to show the images of X-ray of the arteries or the veins.

The health care professional can check to see if you have compression of the vein or artery. If a vein or artery is a blood clot, doctors can administer medication through the catheter to dissolve the clot.

Treatment

A conservative approach to treatment can be effective for most individuals, especially if their condition is diagnosed on time. Treatment may include:

  • The physical therapy. If you have neurogenic thoracic outlet syndrome, physical therapy is the first-line treatment. The strengthening and stretching exercises of the muscles of the shoulders to open the thoracic outlet. This improves the range of motion and posture. These exercises, done over time, can take the pressure of the blood vessels and nerves in the thoracic outlet.
  • Drugs. You may be prescribed anti-inflammatory medications, analgesics or muscle relaxants. Medications to reduce inflammation, reduce pain and promote muscle relaxation. If there is a blood clot, you may need a blood thinner.
  • Thrombolytic drugs. If you have venous or arterial thoracic outlet syndrome and has blood clots, you may be given a medicine to dissolve blood clots. The drug, known as thrombolytics, is introduced in the veins or arteries to dissolve blood clots. After you've given a clot-dissolving drug, your healthcare provider may prescribe medicines to prevent blood clots, known as anticoagulants.
  • Injections. Injections of a local anesthetic, onabotulinumtoxinA (Botox) or a steroid medicine can be used to treat neurogenic thoracic outlet syndrome. The injections can help to reduce pain.

Surgical options

Your health care professional may recommend surgery if conservative treatments have not been effective. Or you might want to consider surgery if you experience ongoing or worsening of symptoms.

A surgeon trained in surgery of the chest, known as the thoracic surgeon, or of the blood vessels of the surgery, known as a vascular surgeon, who usually performs the procedure.

Thoracic outlet syndrome surgery, there are risks of complications, such as damage to the nerves known as the brachial plexus. Also, the surgery may not relieve your symptoms or only partially relieve their symptoms, and the symptoms may return.

Surgery to treat thoracic outlet syndrome, called the thoracic outlet decompression, may be done using several different approaches. These approaches involve the extraction of a muscle and a portion of the first rib to relieve the compression. You may also need surgery to repair damaged blood vessels.

In venous or arterial thoracic outlet syndrome, the surgeon can deliver medication to dissolve blood clots before the thoracic outlet decompression. Or you may need a procedure to remove a blood clot from the vein or artery, or the repair of the vein or artery. The procedure is performed before the thoracic outlet decompression.

If you have arterial thoracic outlet syndrome, the surgeon may need to replace the damaged artery. This is done with a cross section of an artery from another part of your body, known as a graft. Or a graft artificial can be used. This procedure can be done at the same time as a procedure to the first rib removed.

Lifestyle and home remedies

If you are diagnosed with thoracic outlet syndrome, a physical therapist can teach you exercises to do at home. The exercises can strengthen and support the muscles surrounding the thoracic outlet.

In general, to avoid unnecessary stress on the shoulders and the muscles surrounding the thoracic outlet:

  • Maintain a good posture.
  • Take frequent breaks at work to move and stretch.
  • Maintain a healthy weight.
  • Create a work area that allows you to maintain a good posture and does not worsen the symptoms.
  • Gently massage your shoulders and the thoracic outlet.
  • Apply a heating pad to the area.
  • Practice relaxation exercises like deep breathing, meditation and stretching.

Coping and support

Symptoms associated with the thoracic outlet syndrome can be caused by a number of other conditions. This can make it difficult to diagnose. Many people experience the thoracic outlet syndrome symptoms for years before being diagnosed with the disease. Discuss your concerns with your health care professional if symptoms persist and a diagnosis has not been made.

Preparing for your appointment

It is likely to start by seeing your health care professional. Or you may be referred to a doctor trained in the blood vessels of the conditions or in the blood vessels of the surgery, known as a vascular surgeon.

Here's some information to help you prepare for your appointment.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there is something that you need to do before getting to the office.
  • Write down any symptoms you're experiencing, including any that seem unrelated to the reason for which you scheduled the appointment. Be as specific and detailed as possible in the description of the symptoms, including what part of your body is affected, and how the discomfort that makes you feel.
  • Write down key personal information, including any physical trauma you've experienced, such as a car accident or work-related injury. Include the information even if the injury occurred years ago. Also take note of any repetitive physical activities that you do or have done in the past. This can include activities at work, in sports, and for hobbies and other recreational activities.
  • The list of your key medical information, including other conditions for which you are receiving treatment. Also include the names of any prescription medications and over the counter medications or supplements you may be taking.
  • Have a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
  • Write questions to ask their health professional.

Prepare a list of questions will help you make the most of your time. For the thoracic outlet syndrome, some basic questions to ask include:

  • What is the most likely cause of my symptoms?
  • What kinds of tests do I need?
  • What treatments are available, and what treatment do you recommend?
  • What are the chances of non-surgical treatments to improve my symptoms?
  • If conservative treatments are not effective, surgery is an option?
  • Is there anything I can do to prevent a recurrence of this problem?
  • Should I change my job?
  • I need to limit or forego other activities that may be the cause of my symptoms?
  • If you are recommending weight loss, how much weight should I lose to notice an improvement in symptoms?
  • I have other health conditions. How can I best deal with this condition?
  • Are there brochures or other printed material that I can take my house? What sites do you recommend to visit?

Don't hesitate to ask any questions you may have.

What to expect from your doctor

It is likely that you will be asked several questions, such as:

  • When did you first notice your symptoms?
  • How would you describe your symptoms?
  • The symptoms changed over time?
  • Where the pain seem to start and where does it go from there?
  • Does the pain or numbness worse when you lift your arms overhead?
  • Nothing else seems to improve or worsen your symptoms?
  • What do you do in your job?
  • Do you or do you do sports?
  • What are your hobbies or more frequent recreational activities?
  • Have you been diagnosed or treated for any other medical condition? When?
  • Have you noticed a lack of color or a color change in one or more of your fingers or your entire hand? Have you noticed other changes in the area?

What you can do in the meantime

While you're waiting for your appointment, try taking a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin IB, others). Your discomfort may also be improved if you want to maintain good posture and to avoid the use of repetitive movements and lifting heavy objects.

Symptoms and treatment of Thoracic outlet syndrome