Understanding Thoracic Outlet Syndrome: Causes, Symptoms, and Treatment Options

Thoracic outlet syndrome (TOS) is a condition that occurs when the nerves, blood vessels, or muscles in the space between your lower neck and upper chest (thoracic outlet) become compressed. This compression can lead to pain, numbness, and tingling in your arms and shoulders, especially when you raise your arms. TOS is more common in women and can affect anyone, particularly athletes and workers who perform repetitive arm motions.

Types of Thoracic Outlet Syndrome

There are three main types of TOS:

1. Neurogenic TOS: Affects the nerves leading from the spinal cord to the neck and arm. This is the most common type, accounting for about 95% of cases.

2. Venous TOS: Affects the veins in the thoracic outlet area.

3. Arterial TOS: Affects the arteries in the thoracic outlet area. This type is rare but more serious.

Symptoms of Thoracic Outlet Syndrome

Symptoms of TOS are most often felt in the arms and hands, and may include:

• Pain in the neck, shoulder, or arm

• Numbness and tingling

• Swelling

• Weakness

• Discoloration (blue, red, or pale skin)

• Cold hands

• Muscle atrophy (wasting) in the arm

• Weak pulse in the affected arm

• Painful lump near the collarbone

• Shrinking of the muscle at the base of the thumb (Gilliatt-Sumner hand)

Causes and Risk Factors of Thoracic Outlet Syndrome

Several factors can contribute to the development of TOS, including:

• Injuries (e.g., whiplash, broken collarbone)

• Poor posture (rounded shoulders)

• Repetitive stress from certain arm movements

• Physical defects (e.g., extra rib, smaller thoracic outlet)

• Obesity

• Pregnancy

• Sleep disorders

• Tumors in the upper chest or under the arm

• Stress or depression

• Cervical rib

• Blood clots or Aneurysm

• Catheter use

• Carrying heavy bags on the shoulder

Diagnosing Thoracic Outlet Syndrome

Diagnosing TOS can be challenging, as symptoms may be similar to other conditions such as arthritis, pinched nerves, or carpal tunnel syndrome. Your doctor will begin with a detailed history of your symptoms and a physical exam. They may also recommend various tests, including:

• Positioning tests

• Scalene muscle block

• Imaging tests (e.g., X-ray, CT scan, MRI, ultrasound)

• Nerve tests

• Blood circulation tests (e.g., arteriogram, venogram)

Treatment Options for Thoracic Outlet Syndrome

Treatment for TOS depends on the specific type and severity of the condition. For neurogenic TOS, treatment may include:

• Physical therapy to stretch and strengthen muscles, and improve posture

• Medications (e.g., muscle relaxants, NSAIDs) to relieve pain and swelling

• Botox injections to relax muscles at the base of the neck

• Surgery, in some cases

For venous and arterial TOS, treatment typically involves addressing any blood clots and performing thoracic outlet decompression surgery to create more space for nerves and blood vessels.

In addition to medical treatment, your doctor may recommend lifestyle changes and home remedies to help manage TOS, such as maintaining a healthy weight, setting up an ergonomic workstation, taking frequent breaks, and practicing relaxation techniques.

If left untreated, TOS can lead to serious complications, including chronic pain, nerve damage, blood flow problems, and blood clots. It is essential to seek prompt medical attention if you experience symptoms of TOS.

For more information on thoracic outlet syndrome, visit:

• Mayo Clinic: Thoracic Outlet Syndrome

• Johns Hopkins Medicine: Thoracic Outlet Syndrome (TOS)

• National Institute of Neurological Disorders and Stroke: Thoracic Outlet Syndrome Information Page