Thoracic Outlet Syndrome

Thoracic Outlet Syndrome is a rare disease that is not very common. This disease can happen at any age, and women are more prone to suffer from this than men.

What is Thoracic Outlet Syndrome (TOS)?

Thoracic outlet syndrome refers to multiple disorders that occur when the thoracic outlet’s blood vessels and nerves get compressed. 

The area or the narrow space between the collarbone and the first rib is known as the thoracic outlet. 

Due to compression, the rising pressure on the nerves and blood vessels causes pain in your shoulders, neck, arms, and also you may experience numbness in your fingers. 

Types of Thoracic Outlet Syndrome

Three main types of Thoracic Outlet Syndrome are there. They are-

  • Neurogenic Thoracic Outlet Syndrome
  • Venous Thoracic Outlet Syndrome
  • Arterial Thoracic Outlet Syndrome 

Neurogenic TOS

It is one of the most common types of thoracic outlet syndrome that people suffer from. Around 90-95% of thoracic outlet syndrome cases are of Neurogenic type. This condition is caused due to the compression of the brachial plexus.

Brachial plexus is a network of nerves that stretches from the spine through the neck to the arms.  

Neurogenic TOS mostly occurs in the people who frequently or repetitively do hand movements. 

People who play sports like baseball and swimming also develop this condition. 

This condition also develops in those who experience severe injury or any trauma to the chest or neck due to an accident. 

In some cases, the person born with an extra rib above the others, that puts pressure on the nerves in that area and develops TOS.

This type of TOS causes pain, numbness, weakness in the arm, headaches, and tingling. 

 Venous TOS

This type of TOS occurs due to the compression of the subclavian vein. The vein that carries blood from the upper extremities (includes shoulder, hand, and arms ) and brings it back to the heart, the vein is known as subclavian vein.  

Continuous overuse of arm and shoulder during sports or work leads to this condition. This condition can develop due to blood clots also.  

 Venous TOS causes swelling in the arms, swollen veins in the area where the shoulder meets the chest, and bluish skin in the arms.  

Arterial TOS

This condition is infrequent, and it happens when a blood clot occurs in the subclavian arteries. It carries blood from the arms to the heart and vice-versa.  

It is one of the least common thoracic outlet syndromes among the three. Only 1 % of cases are of Arterial TOS. 

Arterial TOS causes coldness, tingling, numbness, and pain in the arms and hands. Sometimes hands may appear white, or you may notice tiny blood clots in the fingers.  

Signs & Symptoms of Thoracic Outlet Syndrome

 The symptoms of thoracic outlet syndrome vary upon the type of TOS the person suffering from.

Here are the symptoms according to the TOS types-

Symptoms of Neurogenic  Thoracic Outlet Syndrome

Neurogenic Thoracic Outlet Syndrome

 affects the nerves. 

  • Pain in the arm and shoulder.
  • Weakness in the arm and shoulder.
  • Pain or discomfort in the neck.
  • Arms get tired promptly. 
  • Numbness in the arm and especially in the fingers.
  • Tingling sensation.
  • Gilliatt- Sumner hand.
  • Handgrip begins to weaken. 

Symptoms of Venous  Thoracic Outlet Syndrome

Venous Thoracic Outlet Syndrome destroys the veins. 

  • Swelling in the arm, hand, and fingers.
  • Tingling sensation in the arm.
  • Weakness in the arm.
  • Blueness in the arms and hands.
  • Swollen veins where the shoulder and the chest meets.
  •  A blood clot may occur in the veins or arteries of the upper body. 
  • Fingers or arms became pallor and dull.
  • Coldness in the fingers, arms, and hands.
  • Fatigue arms.
  • Weakness in the neck.
  • A throbbing lump may appear near your collarbone.

Symptoms of Arterial  Thoracic Outlet Syndrome

Arterial Thoracic Outlet Syndrome

 affects the arteries. 

  • Cold and paler arms.
  • Pain in the hand and arms. 
  • Blockage of an artery in the arm.
  • Swelling or inflammation of the subclavian artery wall. 

Causes of Thoracic Outlet Syndrome

Thoracic outlet syndrome is caused by the compression of nerves, arteries, or veins, located under the collarbones (clavicle).  

The causes of the compression include-

  • Anatomical defect/ Extra rib

An anatomical defect that is an extra rib is located above the cervical rib (first rib) present at birth (congenital). The presence of a spare rib may increase the compression of blood vessels or nerves. 

  • First rib formation 

In some cases, it has been seen that some people have an extra aberrant scalene muscle (inner muscle of the neck) or absence of this muscle, both the condition can lead to thoracic outlet syndrome.

  • Trauma (Whiplash injury)

A car accident or any such traumatic event can cause internal injury or squeeze of blood vessels or nerves in the thoracic outlet area, which later can lead to thoracic outlet syndrome. 

  • Weightlifting 

Heavy weightlifting can also put stress on blood vessels. 

  • Weight gain/ Obesity

Obesity means the accumulation of extra muscle mass or fat. Excess fat around the neck can compress the subclavian vessels.  

  • Repetitive activity

Jobs that require repetitive hand movements such as swimming, baseball playing, painting, or any kind of job that requires raised arms for a long time may develop thoracic outlet syndrome.

  • Pregnancy

Signs & Symptoms of thoracic outlet syndrome may appear during pregnancy. 

  • Tumour in the neck

Tumour in the neck causes compression of nerves, arteries, or veins and can eventually develop into thoracic outlet syndrome. Well, it happens in some rare cases.

Thoracic Outlet Syndrome Treatment

Numerous treatment options are available for this condition. 

  • Physical therapy

Physical therapy is one of the most common treatments and initial treatments for thoracic out syndrome. 

Physical therapy helps to strengthen the shoulder muscles, and it also supports the collarbone and muscles around the thoracic outlet area.

  • Medication 

Medicines are used to ease the symptoms and reduce the pain and inflammation. To prevent the formation of blood clots, doctors may also prescribe anticoagulants.

  • Surgery 

In some cases, it requires surgery to treat thoracic outlet syndrome. If medications or physical therapy don’t show any improvement in your symptoms, only then the doctor will opt for surgery. 

The treatment of thoracic depends upon the type of thoracic outlet syndrome people suffering from. Doctors first need to identify the type of thoracic. 

Diagnose of Thoracic Outlet Syndrome

To diagnose your thoracic outlet syndrome, doctors will examine your symptoms. They will ask for a complete medical history of yours, some provocation, and additional tests to confirm the diagnosis. 

The tests may include-

  • Duplex ultrasound
  • Chest X-ray
  • MRI (Magnetic Resonance Imaging)
  • Electromyography (EMG)
  • CT scan (Computerized Tomography)
  • Angiography
  • Arteriography
  • Venography
  • Nerve conduction study

Neurogenic Thoracic Outlet Syndrome Treatment 

Physical therapy

It is the first initial treatment that doctors opt for neurogenic thoracic outlet syndrome. Many patients experience improvement after physical therapy. 

Medications

To ease pain and inflammation, doctors may prescribe some medicines such as- aspirin, ibuprofen, acetaminophen, or some ointment to reduce the pain.  

Surgery

In some neurogenic thoracic cases, when conditions or symptoms don’t improve after physical therapy, surgery may be needed.  

Venous Thoracic Outlet Syndrome Treatment

  • Anticoagulant medications

In venous thoracic, usually, doctors prescribe anticoagulant medicines. These medications decrease the formation of a blood clot.  

  • Thrombolytic medications

Thrombolytic medicines are clot-dissolving medicine. The medicines help to liquefy the blood lumps. 

This medication is given by doctors in the hospital. 

  • Thrombolysis 

Thrombolysis is a procedure to eliminate blood lumps from the vein. This procedure is usually done before the surgery of thoracic outlet syndrome. 

  • Surgery 

In venous thoracic, surgery is usually conducted after the thrombolysis procedure. 

Arterial Thoracic Outlet Syndrome Treatment

  • Thrombolytic medications

Thrombolytic medications are given directly into the artery via a catheter. These medications are only given in the hospital by doctors because, in this procedure, patients need to be monitored closely.  

  • Medications

Blood thinner medications are required to prevent the formation of blood clots in the artery. 

  • Surgery

In most arterial TOS cases, patients require surgery.

In this surgery, the surgeon removes the first rib to enhance space for vessels and nerves.

In some cases, surgery is also required to fix any structural problem of the artery.  

Prevention from Thoracic Outlet Syndrome 

You cannot prevent any severe illness from happening, but you can do several things to reduce it and prevent it from progressing. 

To prevent thoracic outlet syndrome from progressing follow the underlying steps-

  • Avoid weight lifting
  • Perform muscle-strengthening exercises daily 
  • Maintain a healthy weight.
  • Maintain a proper posture while sitting or standing.
  • Avoid repeating hand movements.
  • Avoid carrying heavy objects or bags on your shoulder. 

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