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Thoracic Outlet Syndrome occurs as a result of compressed nerves or blood vessels within the thoracic outlet. Affected individuals have to deal with a throbbing pain in the shoulders and neck. The syndrome also causes the fingers to get numb and itchy. Sufferers also find that they can’t hold anything in their hands for any significant period of time. The condition warrants early diagnosis and treatment to avoid damaging the nerve permanently.

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The treatment for Thoracic Outlet Syndrome aims to help patients by alleviating the accompanying symptoms. It is designed based on the underlying cause and severity of the syndrome. The treatment employed may be a combination of pain management technique and physical therapy. While these methods work in most patients, others require stronger treatment approach like surgery.

Thoracic Outlet Syndrome causes

In TOS or thoracic outlet syndrome, the nerves and blood vessels within the region of the thoracic outlet get compressed, resulting in abnormal and painful sensations felts on the thoracic area. The thoracic outlet lies between the chest and neck just above the ribcage and below the collarbone. Blood vessels, nerves, trachea and esophagus pass through the area of thoracic outlet.

Movement or enlargement of tissues around the region of the thoracic outlet compresses the nerves and blood vessels, resulting in the occurrence of TOS. TOS may happen due the following reasons:

  • Physical trauma

A car accident is a good example of physical trauma associated to TOS as this can give rise to internal modifications, resulting in compression of the nerves in the thoracic outlet. Even if the physical trauma occurred a long time ago, it is still possible to result in TOS.

  • Repetitive movements

Body tissues will eventually deteriorate after doing the same activities over and over again for a long period of time. These activities could be sports or work-related.

  • Anatomical defects

These are often inherited and noticeable at birth. Examples of these are an extra rib and abnormal fibrous band.

  • Poor posture

Poor posture, which is characterized by drooping shoulders and head-forward position, is another culprit of TOS.

  • Pregnancy

Loose joints are common during pregnancy and can cause TOS.

  • Joint pressure

Carrying an oversized backpack and obesity can put too much stress on the joints which may result to TOS.

Thoracic Outlet Syndrome Types

Thoracic Outlet Syndrome is displayed in a variety of ways since there are three types of TOS.

  • Neurogenic

This type of TOS occurs due to neck trauma. Sufferers experience pain, tingling sensation, numbness and weak hands and arms. Some people feel a radiating pain from the shoulder to the arms and fingertips.

  • Venous

The venous variety of TOS is a result of persistent use of the shoulders and arms.  The patient feels some pain, swelling and discoloration throughout his/her arms.

  • Arterial

Arterial TOS is caused by the narrowing of the sub-clavian artery. This type of TOS is manifested by pain, pale discoloration and coldness of the hands. Sufferers typically notice that their arms cramp up when they perform activities.

It would be best for the affected individuals to seek medical advice after experiencing the symptoms of TOS. This is especially important if the syndrome is hindering the person from doing his/her regular activities.

Thoracic Outlet Syndrome Statistics

Thoracic Outlet Syndrome rarely occurs, as it only affects 1 out of 1 million people. The syndrome had been found to mainly affect people whose work involves repetitive movements and prolonged neck posturing, like cashiers, secretaries, machine operators, truck drivers and surgeons. The syndrome also affects people engaged in overhead work. Studies also found that the condition is quite common among people with droopy shoulders and long necks. Research also showed that TOS affects more women than men. The age of onset starts as early as childhood and as late as middle age.

Thoracic Outlet Syndrome Tests

The syndrome should never be left untreated due to the danger of causing permanent damage to the nerve. Diagnosis may be tricky because its sufferers exhibit different symptoms and severity. However, early detection helps in preventing the disorder from causing further damage.

TOS diagnosis involves a combination of the following procedures.

  • Physical examination

This is done to assess the external signs like drooped shoulders, limited motion and discoloration of arms.

  • Medical history

This often involves knowing the physical activities, job, symptoms and medical history of the patient.

  • Provocation tests

The doctor will try to mimic the TOS symptoms in order to rule out other conditions with the same symptoms. Wright test, Adson’s maneuver and Roos stress test are examples of provocation tests.

  • Imaging

Imaging like EMG, MRI and X-ray, helps doctors determine the presence of cervical rib and any underlying health condition.

  • Nerve studies

This will help the doctor know the extent of nerve damage.

The prognosis differs with every patient depending on the type and severity of the thoracic outlet syndrome. While physical therapy is enough for most patients, some would require surgical procedure with 50% to 80% chance of recovery.

Thoracic Outlet Syndrome Exercises (Treatment)

Treatment for Thoracic Outlet Syndrome is done in the form of targeted exercises that stretch the thoracic outlet tissues open. The physiotherapist may ask you to use weights or do free-weights to pull the outlet into a contracted position. A few of the recommended exercises are centered around shoulder and are known as ‘shoulder-shrug’ exercises which can be done at home too.

Patients should steer away from outstretching their arms too much or holding them overhead for extended amounts of time. Avoid sleeping on stomach with  arms above the head or behind the head.  Also do not repeatedly lift heavy objects.

In severe cases of Thoracic Outlet Syndrome, the patient may need to undergo surgery which can open the thoracic outlet. In this procedure, the first rib is removed so that the affected nerve and blood vessels are not deteriorated further.

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