Thoracic outlet syndrome (TOS)
What is thoracic outlet syndrome? Thoracic outlet syndrome (TOS) is a term used to describe a group of disorders that occur when there is compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest area. Thoracic outlet syndrome is named for the space (the thoracic outlet) between your lower neck and upper chest where this grouping of nerves and blood vessels is found.
Thoracic Outlet Space
What causes thoracic outlet syndrome?
The disorders caused by TOS are not well understood. Yet, it is known that when the blood vessels and/or nerves in the tight passageway of the thoracic outlet are abnormally compressed, they become irritated and can cause TOS. Thoracic outlet syndrome can be a result of an extra first rib (cervical rib) or an old fracture of the clavicle (collarbone) that reduces the space for the vessels and nerves. Bony and soft tissue abnormalities are among the many other causes of TOS.
The following may increase the risk of developing thoracic outlet syndrome:
The pain of TOS is sometimes confused with the pain of angina (chest pain due to an inadequate supply of oxygen to the heart muscle), but the two conditions can be distinguished because the pain of thoracic outlet syndrome does not occur or increase when walking, while the pain of angina usually does. Additionally, the pain of TOS typically increases when raising the affected arm, which does not occur with angina.
Signs and symptoms of TOS help determine the type of disorder a patient has. Thoracic outlet syndrome disorders differ, depending on the part(s) of the body they affect. Thoracic outlet syndrome most commonly affects the nerves, but the condition can also affect the veins and arteries (least common type). In all types of TOS, the thoracic outlet space is narrowed, and there is scar formation around the structures.
Types of thoracic outlet syndrome disorders and related symptoms
Thoracic outlet syndrome affects people of all ages and gender. The condition is common among athletes who participate in sports that require repetitive motions of the arm and shoulder, such as baseball, swimming, volleyball, and other sports.
Neurogenic TOS is the most common form of the disorder (95 percent of people with TOS have this form of the disorder) and generally affects middle-aged women.
Recent studies have shown that, in general, TOS is more common in women than men, particularly among those with poor muscular development, poor posture or both.
How is thoracic outlet syndrome diagnosed? Is thoracic outlet syndrome serious? Although many cases of thoracic outlet syndrome (TOS) can’t be prevented, the condition is treatable. If left untreated, TOS can cause complications, such as:
How is thoracic outlet syndrome treated?
Early identification of TOS can help improve the success of treatment. Thoracic outlet syndrome treatments vary, depending on the type of TOS you have and your symptoms. The goals of treatment are to reduce symptoms and pain. Your health care provider will recommend the treatment option that is right for you.
Before choosing any treatment, it is important to talk to your health care provider about the potential benefits, risks and side effects of your treatment options.
Treatment of neurogenic thoracic outlet syndrome
What is thoracic outlet syndrome? Thoracic outlet syndrome (TOS) is a term used to describe a group of disorders that occur when there is compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest area. Thoracic outlet syndrome is named for the space (the thoracic outlet) between your lower neck and upper chest where this grouping of nerves and blood vessels is found.
Thoracic Outlet Space
What causes thoracic outlet syndrome?
The disorders caused by TOS are not well understood. Yet, it is known that when the blood vessels and/or nerves in the tight passageway of the thoracic outlet are abnormally compressed, they become irritated and can cause TOS. Thoracic outlet syndrome can be a result of an extra first rib (cervical rib) or an old fracture of the clavicle (collarbone) that reduces the space for the vessels and nerves. Bony and soft tissue abnormalities are among the many other causes of TOS.
The following may increase the risk of developing thoracic outlet syndrome:
- Sleep disorders
- Tumors or large lymph nodes in the upper chest or underarm area
- Stress or depression
- Participating in sports that involve repetitive arm or shoulder movement, such as baseball, swimming, golfing, volleyball and others
- Repetitive injuries from carrying heavy shoulder loads
- Injury to the neck or back (whiplash injury)
- Poor posture
- Weightlifting
- Wasting in the fleshy base of your thumb (Gilliatt-Sumner hand)
- Numbness or tingling in your fingers
- Pain in your shoulder and neck
- Ache in your arm or hand
- Weakening grip
The pain of TOS is sometimes confused with the pain of angina (chest pain due to an inadequate supply of oxygen to the heart muscle), but the two conditions can be distinguished because the pain of thoracic outlet syndrome does not occur or increase when walking, while the pain of angina usually does. Additionally, the pain of TOS typically increases when raising the affected arm, which does not occur with angina.
Signs and symptoms of TOS help determine the type of disorder a patient has. Thoracic outlet syndrome disorders differ, depending on the part(s) of the body they affect. Thoracic outlet syndrome most commonly affects the nerves, but the condition can also affect the veins and arteries (least common type). In all types of TOS, the thoracic outlet space is narrowed, and there is scar formation around the structures.
Types of thoracic outlet syndrome disorders and related symptoms
- Neurogenic thoracic outlet syndrome: This condition is related to abnormalities of bony and soft tissue in the lower neck region (which may include the cervical rib area) that compress and irritate the nerves of the brachial plexus, the complex of nerves that supply motor (movement) and sensory (feeling) function to the arm and hand. Symptoms include weakness or numbness of the hand; decreased size of hand muscles, which usually occurs on one side of the body; and/or pain, tingling, prickling, numbness and weakness of the neck, chest, and arms.
- Venous thoracic outlet syndrome: This condition is caused by damage to the major veins in the lower neck and upper chest. The condition develops suddenly, often after unusual and tiring exercise of the arms. Symptoms include swelling of the hands, fingers and arms, as well as heaviness and weakness of the neck and arms. The veins in the anterior (front) chest wall veins also may appear dilated (swollen).
- Arterial thoracic outlet syndrome: The least common, but most serious, type of TOS is caused by congenital (present at birth) bony abnormalities in the lower neck and upper chest. Symptoms include cold sensitivity in the hands and fingers; numbness, pain or sores of the fingers; and poor blood circulation to the arms, hands and fingers.
Thoracic outlet syndrome affects people of all ages and gender. The condition is common among athletes who participate in sports that require repetitive motions of the arm and shoulder, such as baseball, swimming, volleyball, and other sports.
Neurogenic TOS is the most common form of the disorder (95 percent of people with TOS have this form of the disorder) and generally affects middle-aged women.
Recent studies have shown that, in general, TOS is more common in women than men, particularly among those with poor muscular development, poor posture or both.
How is thoracic outlet syndrome diagnosed? Is thoracic outlet syndrome serious? Although many cases of thoracic outlet syndrome (TOS) can’t be prevented, the condition is treatable. If left untreated, TOS can cause complications, such as:
- Permanent arm swelling and pain (especially in patients with venous TOS)
- Ischemic ulcer of the fingers (open sore caused by reduced blood flow)
- Gangrene (the death of body tissue, often caused by a loss of blood flow)
- Blood clot
- Pulmonary embolism (obstruction in a blood vessel due to a blood clot)
- Neurogenic complications, such as permanent nerve damage
How is thoracic outlet syndrome treated?
Early identification of TOS can help improve the success of treatment. Thoracic outlet syndrome treatments vary, depending on the type of TOS you have and your symptoms. The goals of treatment are to reduce symptoms and pain. Your health care provider will recommend the treatment option that is right for you.
Before choosing any treatment, it is important to talk to your health care provider about the potential benefits, risks and side effects of your treatment options.
Treatment of neurogenic thoracic outlet syndrome
- Physical therapy: The most common initial treatment for neurogenic thoracic outlet syndrome is physical therapy. Physical therapy increases the range of motion of the neck and shoulders, strengthens muscles and promotes better posture. Most patients experience an improvement in symptoms after undergoing physical therapy.
- Medications: For pain relief, over-the-counter pain medications, such as aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin), may be recommended. Your doctor may prescribe a muscle relaxant for additional pain relief.
- Surgery: In some cases, surgery may be needed to treat neurogenic thoracic outlet syndrome if symptoms continue, despite an optimal course of physical therapy.