Information From Your Health Care Provider

THORACIC OUTLET SYNDROME

Basic information

description

Thoracic outlet syndrome (TOS) is a general term used to describe symptoms that occur due to pressure on nerves and blood vessels in the neck area. The thoracic outlet is a space between the rib cage and the collarbone. TOS affects females more often than males.

FREQUENT SIGNS & SYMPTOMS

Numbness, tingling, or prickling feelings in the neck, shoulders, arms, or hands.
There may be no pain or mild to more severe pain.
Weakness and tiredness in the arms and hands.
Poor blood flow that causes coldness, swelling, and blueness in the hands and fingers (rare).
Sense of touch may be lost.

causes

Nerves and blood vessels that supply the shoulder, arms, and hands begin in the neck. They then pass as a bundle near the cervical ribs and collarbone. Pressure on this nerve and blood vessel bundle creates symptoms. There are multiple problems that can lead to the pressure.

risk increases with

An extra rib in the body. It may have fiber-like bands attached to it.
Overextending arm or shoulder or repeated overhead arm movements. This may be due to work activities or exercise.
Carrying heavy loads.
Fracture of clavicle (collarbone) or first rib.
Drooping shoulders or head due to poor posture.
Tumor or blood clots.
Obesity.
Pregnancy.
Other health or emotional disorders may make a person more at risk for TOS.

PREVENTIVE MEASURES

No specific preventive measures. Try to avoid repetitive arm and shoulder activities and overhead arm tasks. Exercise daily to maintain good physical fitness.

expected outcomes

With treatment, symptoms can be relieved in most patients.

possible complications

Problem can recur.
If surgery is performed, it may have complications.
Chronic pain syndrome, disability, and depression may occur in some patients.
Some loss of function in arm and shoulders.

diagnosis & treatment

general measures

Your health care provider will do a physical exam and ask questions about your symptoms and activities. You may be asked to make certain movements with the head, arm, and shoulders to help find the cause of the symptoms. Other medical tests may be done to rule out problems that could cause similar symptoms.
Treatment may involve physical therapy, stretching and strengthening exercises, drugs, ultrasound therapy, electrical stimulation, manipulation, or (rarely) surgery. Your health care provider will discuss an individual plan for you depending on your symptoms.
Use heat to help relieve pain. Use a heating pad, warm showers, or warm, moist compresses.
Surgery may be a final option when other treatments are not helpful. It may relieve pressure on the nerves and blood vessels.

medications

You may use nonprescription drugs, such as acetaminophen or aspirin (not for children), to relieve pain. Drugs cannot correct the underlying condition.
Other drugs or injections for specific symptoms may be prescribed.

activity

Physical therapy and exercise will be prescribed to promote shoulder muscle function and improve any posture faults. These are usually recommended for 2 to 3 months.
Avoid straining or heavy activity for 3 months.