Thoracic Outlet Syndrome
Thoracic Outlet Syndrome (TOS) involves compression of the nerves, arteries, and veins in the lower neck and upper chest area and can cause various symptoms in the arm, shoulder, and neck depending on anatomic structure most compressed. Symptoms include pain, swelling, tingling or numbness among others.
TOS Symptoms & Diagnosis
Thoracic Outlet Syndrome is caused by compression between the neck and shoulder muscles and between the first rib and collarbone.
It can feel like burning, tingling, numbness, or even weakness as well as pain along the arm, hand, and fingers if nerve compression is present. If a vein is compressed, it may also cause swelling or pain. Compression of an artery can lead to pain or coolness of the hand. Finally, there is the possibility of compression of more than one structure at a time leading to overlapping symptoms.
There are many causes of TOS, including
- Abnormal anatomy
- Poor posture
- Repetitive arm and shoulder movements
TOS is more common in women than in men and usually starts between 20 and 50 years of age. It is diagnosed through careful history taking and examination of the patient. Together with BIDMC specialists from Neurophysiology, Diagnostic Radiology, and Pain Center additional diagnostic studies are obtained such duplex ultrasound examination, MRI, nerve conduction studies, and targeted injections with local anesthetics.
Treatment at BIDMC
Treatment begins with exercise programs and physical therapy to strengthen chest muscles, restore normal posture, and relieve compression by increasing the space of the area. Doctors will often prescribe non-steroidal anti-inflammatory drugs (such as ibuprofen) for pain. This is often the first step for TOS of the nerves (neurogenic). Other medicines are sometimes prescribed to either prevent or break up blood clots if venous or arterial TOS is the main problem.
If physical therapy and medication do not relieve the symptoms, a doctor may recommend thoracic outlet decompression surgery to release the compression nerves, artery and vein. BIDMC Vascular Surgeon Lars Stangenberg, MD, PhD, has extensive experience in decompression surgery for TOS.