Thoracic outlet syndrome (TOS) is a group of disorders that occurs when blood vessels or nerves between the clavicle and the first rib (thoracic outlet space) become compressed. This can cause pain in the shoulders and neck and numb fingers.
Common causes of thoracic outlet syndrome include:
- Bodily injuries from a car accident.
- Recurrent injuries from work-related activities or sports.
- Having specific anatomical defects (such as having an extra rib).
Sometimes doctors cannot diagnose the cause of thoracic outlet syndrome. Treatment for this syndrome usually includes physical therapy and pain relief. Most people get significant improvement with these methods. However, in some cases, your doctor may recommend surgery.
In general, the cause of TOS is the compression of nerves or blood vessels in the thoracic outlet just below the clavicle. The cause of this compression is different and can include the following:
An inherited defect at birth (congenital) in an individual may include an extra rib above the first rib (cervical rib) or an abnormal tightness of the fibrous band that connects the spine to the ribs.
Dropping your shoulders or keeping your head forward can cause compression in the chest outlet area.
An accident, such as a car accident, can cause internal changes and thus compress the thoracic outlet nerves. The onset of symptoms of a traumatic event is often delayed.
Doing a constant job repeatedly can lead to wear and tear over time. Suppose your job requires you to constantly repeat a movement, such as typing on a computer, working on an assembly line, or lifting equipment to the top of your head. In that case, you may experience symptoms of thoracic outlet syndrome. Athletes such as baseball throwers and swimmers may also develop chest outflow syndrome due to years of repetitive movements for many years.
Pressure on the Joints
Obesity can put a lot of pressure on your joints, just as carrying a large bag or heavy backpack can affect your body.
Because the joints become loose during pregnancy, symptoms of TOS may appear during pregnancy.
Symptoms of Thoracic Outlet Syndrome
There are several types of TOS, including:
- Thoracic outlet syndrome and its neural origin (Neurogenic)
This is the most common TOS with compression of the brachial plexus. The brachial plexus is a network of nerves that originates in the spinal cord and controls the movements and sensations of the shoulder, arm, and hand muscles.
- Syndrome of vascular origin
This type of TOS occurs when compressed by one or more vessels (thoracic outlet syndrome) or arteries (arterial thoracic outlet syndrome) located under the clavicle.
- Nonspecific thoracic outlet syndrome. This type is also called disputed thoracic outlet syndrome. Some doctors do not believe it exists, while others consider it a common disorder. People with nonspecific TOS have chronic pain in the thoracic region (base of the neck) that worsens with activity, but no specific cause can be found.
Symptoms of thoracic outlet syndrome can vary depending on the structures being compressed. Signs and symptoms of neurodegenerative TOS include the following when the nerves are compressed:
- Atrophy and muscle contraction at the fleshy base of the thumb (Gilliatt-Sumner’s hand)
- Numbness or tingling in the hands or fingers
- Pain in the neck, shoulders pain, or hand-painted
- Weak power to grab objects
Signs and symptoms of thoracic outlet syndrome may include:
- Hand colour change (bluish colour)
- Pain and swelling in the hands and arms, possibly due to blood clots
- Blood clots in veins or arteries in the upper body
- Pallor on one or more fingers or the whole hand
- Weakness or lack of pulse in the injured hand
- Cooling of fingers or hands
- Excessive hand fatigue with activity
- Numbness or tingling in the fingers
- Feeling weak in the hands or neck
- Pulsating bulge near the clavicle
When should we see a doctor?
You should see your doctor if you continue to see any of the signs and symptoms of Thoracic Outlet Syndrome.
If your symptoms are not treated in time, you may experience progressive nerve damage and need surgery. Doctors only recommend surgery to treat thoracic outlet syndrome when other treatments are ineffective. The risks and potential side effects of surgery are greater than other treatments and may not always help treat your symptoms.
Diagnosis of thoracic outlet syndrome can be difficult because the symptoms and severity are very different in people with the disorder. To diagnose thoracic outlet syndrome, your doctor may review your symptoms and medical history and perform a physical exam.
- Physical examination
Your doctor will perform a physical exam on you to look for external signs of thoracic outlet syndrome, such as drooping shoulders, swelling or discoloration or discoloration of the arms, abnormal heart rate, or limited mobility.
- Medical history
Your doctor will probably ask about your medical history and symptoms and your occupation and physical activity.
- Stimulation tests
Stimulation tests are designed to produce and observe the patient’s symptoms. These tests may help your doctor diagnose the cause of your illness and help rule out other causes that may have similar symptoms.
Your doctor will probably ask you to move your arms, neck, or shoulders in different positions in this test. Your doctor will examine your symptoms and examine you in different situations.
- Imaging tests and nerve study tests
Your doctor may order one or more of the following tests to confirm the diagnosis of TOS:
Risk Factors of Thoracic Outlet Syndrome
Several factors seem to increase the risk of thoracic outlet syndrome, including:
- Gender – Women are more likely than men to develop chest discharge syndrome.
- Age – Chest discharge syndrome is more common in adults between 20 and 40.
treatment for Thoracic Outlet Syndrome
In most cases, a conservative approach to treating this syndrome is effective, especially if your condition is diagnosed early. Treatment for thoracic outlet syndrome may include the following:
Lifestyle changes and home remedies
If you have TOS, your doctor or physiotherapist may recommend doing exercises at home to strengthen and protect the muscles around your chest.
If you have neurodegenerative chest syndrome, physiotherapy will be the first treatment option for your problem. In the physiotherapy program, you will learn how to do exercises that strengthen and stretch your shoulder muscles to open the chest outlet and improve range of motion and posture. These exercises, performed over time, may reduce the pressure on the blood vessels and nerves in the thoracic outlet.
Your doctor may prescribe anti-inflammatory drugs, painkillers, or muscle relaxants to reduce inflammation, reduce pain, and encourage muscle relaxation.
Blood clot-dissolving drugs
Suppose you have venous or arterial TOS and have blood clots in your arteries. In that case, your doctor may prescribe thrombolytic drugs to dissolve the clots in your arteries or veins. After administering thrombolytics, your doctor will prescribe medications to prevent blood clots (anticoagulants).
- Supraclavicular surgery
- Infraclavicular surgery
Suppose TOS goes untreated for years. It can cause permanent damage to the nerves, so it is important to evaluate and treat your symptoms early or take steps to prevent the disorder.
If you are prone to chest tightness, avoid repetitive movements and lifting heavy objects. If you are overweight, you can prevent or reduce the symptoms associated with TOS by losing weight.
Even if you do not have symptoms of TOS, avoid carrying heavy bags on your shoulders, as this can increase the pressure on the thoracic outlet duct. Do stretching exercises daily and do exercise therapy that keeps your shoulder muscles strong.
Daily stretching by focusing on the chest, neck, and shoulders can help improve shoulder muscle strength and prevent thoracic outlet syndrome.