THORACIC OUTLET SYNDROME (TOS) is a little-known condition that is tricky to diagnosis and treat.
This often painful and disabling disorder results from compression of nerves or blood vessels in the thoracic outlet, a narrow bony, almost triangular opening between the first rib at the top of the rib cage and the clavicle. It can cause a wide range of symptoms including neck, shoulder or arm pain, tingling or swelling in an arm, hand or fingers, weakness in a shoulder, arm or hand and /or impaired circulation in a hand..
Many other conditions(such as diabetes, carpal tunnel syndrome, Raynaud’s disease, fibromyalgia or even a heart attack) can cause similar sensations, making it difficult to diagnosis.
Nerve-related TOS symptoms are different from those caused by pressure on an artery or vein. NERVE PRESSURE accounts for more than 90% of TOS cases. The patient can have pain, numbness or tingling(or all three),that starts in the neck and radiates down to a hand. The discomfort may come and go but usually worsens when the arm is elevated.
PRESSURE ON A VEIN OR ARTERY can restrict blood flow and cause swelling and discoloration of the fingers, hand or arm…or feelings of coldness in the hands.This type of pressure can increase risk for blood clots in the shoulders or arms .
If the physician suspects TOS a chest x-ray is given to detect rib abnormalities, including the presence of a cervical rib. An ultrasound helps to identify blood-vessel abnormalities. Also helpful: An injection of local anesthetic into one of scalene muscles in the neck. Patients with nerve-related TOS, this will often stop the pain almost immediately. The pain relief lasts only for about a day, it is not a treatment, a diagnostic sign.
Physician will also check for abnormal signs of skin color and cool skin, which indicates severly restricted blood flow or a clot
Thoracic Outlet Syndrome (TOS) Treatment
Physical Therapy: Stretching and strengthening shoulder and scapula musculatures, restoring normal posture and relieving compression of
affected muscles often time relieves the problem. However, maintaining proper posture and practicing pelvic stabilization with lengthening the spine and keeping the head on the shoulders, not on the chest throughout the day reduces the reoccurrence.
Massage and acupuncture has helped patients with TOS caused by nerve pressure, even though there is little evidence to prove these
approaches work. However, maintaining proper posture throughout the day along with massage has shown greater success.
Botox injections in the scalene muscles will shrink these muscles and
potentially open up the space in the thoracic outlet to relieve the pressure. More often ,an injection gives relief for only two to four months and repeated injections are needed. Most patients are not willing to keep getting injections. If symptoms have not improved after two to three, the injections probably are not going to work.
If surgery is needed for nerve-related symptoms, the goal of surgery is to remove tissue, bone or muscle that is causing the pressure. For clot-related symptoms, surgery is the standard treatment. It is used to remove clots…reconstruct or replace damaged arteries…or remove bone/muscle that is pressing on the affected area. Patients should follow up with Physical Therapy as part of their rehabilitation.