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Thoracic Outlet Syndrome

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) is a condition that occurs when nerves or blood vessels in the upper chest, near the collarbone and armpit, are compressed. This compression can cause pain, numbness, and weakness in the arm and shoulder.

 

Causes

There are a number of things that can cause TOS, including:

  • Anatomical variations: Some people are born with an extra rib in the neck (cervical rib) or tight muscles in the chest that can compress the nerves and blood vessels.
  • Repetitive overhead activities: Activities that involve repetitive overhead motions, such as weightlifting, painting, or playing certain sports, can irritate the muscles and tendons in the shoulder, leading to TOS.
  • Poor posture: Poor posture, such as slouching or hunching the shoulders, can narrow the thoracic outlet and compress the nerves and blood vessels.
  • Trauma: Injuries to the chest or neck, such as from a car accident or fall, can damage the nerves and blood vessels in the thoracic outlet.

Symptoms

The symptoms of TOS can vary depending on the type of TOS and the severity of the compression. Common symptoms include:

  • Pain in the shoulder, neck, or arm
  • Numbness or tingling in the fingers
  • Weakness in the arm
  • A feeling of heaviness in the arm
  • Changes in skin color in the arm, such as pallor or redness
  • Symptoms that worsen with activity, especially overhead activities

 

Types of Thoracic Outlet Syndrome

There are three main types of TOS:

  • Neurogenic TOS: This is the most common type of TOS. It occurs when the nerves in the thoracic outlet are compressed.
  • Venous TOS: This type of TOS occurs when the veins in the thoracic outlet are compressed. It can cause swelling, pain, and a feeling of heaviness in the arm.
  • Arterial TOS: This is the least common type of TOS. It occurs when the arteries in the thoracic outlet are compressed. It can cause pain, numbness, and weakness in the arm, as well as skin changes and gangrene in severe cases.

 

Treatment

Treatment for TOS typically starts with conservative measures, such as:

  • Physical therapy: Physical therapy can help to improve posture, strengthen the muscles in the chest and shoulder, and improve flexibility.
  • Activity modification: Avoiding activities that aggravate symptoms may be necessary.
  • Pain medication: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help to relieve pain.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs can help to reduce inflammation and pain.
  • Minimally Invasive Procedure: Angioplasty and stenting can be performed to reopen the blocked blood vessels in combination with surgery to relieve the compression (Click here to read more on Angioplasty/ stenting).

 If conservative measures do not improve symptoms, surgery may be necessary to relieve the compression on the nerves or blood vessels.