The thoracic outlet is the area of the lower neck and upper chest. This area has a variety of nerves, blood vessels, muscles and bones that run through a fairly small area. When the nerves and blood vessels of this area are compressed, irritated or injured they can cause a range of symptoms known as the thoracic outlet syndrome (TOS).
Thoracic Outlet Syndrome
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Compression, injury, or irritation of nerves and blood vessels can be caused by: Defects in nearby structuresPoor postureTraumaRepetitive arm or shoulder movementTumors
Factors that may increase your chance of developing TOS include: Having an abnormal first ribPoor postureRepetitive motionTraumaObesity
TOS may cause the following: Arm or hand painArm or hand weaknessNumbness and tinglingCold sensitivity in the hands and fingersPain or sores of the fingersPoor blood circulation to the arm, hands, and fingersSwelling of the limbSkin of arm turning pale and blue
Your doctor will ask about your symptoms and medical history. A physical exam will be done.
During an elevated arm stress test, your doctor will ask you to hold your arms and head in positions that may cause the TOS symptoms to reappear. The results of these tests will help determine whether you have TOS and rule out other possible related conditions.
Other tests may include: Blood testsElectromyography and nerve other conduction tests
Images of internal body structures may be taken with: Chest x-rayUltrasoundCT angiographyMRIVenography
Treatment varies depending on your specific symptoms. In most cases, TOS is managed with pain medication and physical therapy.
Your doctor may recommend the following: Non-steroidal anti-inflammatory drugs (NSAIDs)Muscle relaxersAntidepressantsBlood thinnersAnti-platelets
A physical therapist will design some some exercises for you. The exercises will help to relieve symptoms by relaxing nearby muscles, improving posture and reducing pressure on nerves and blood vessels.
As part of your treatment, you may need to make lifestyle changes. Some of these may include: Avoid activity that causes painPractice good postureAvoid repetitive motionChange your workstation layoutIf you are overweight, talk to your doctor about how you can lose weightExercise regularly to improve strength, flexibility and range of motion
If other treatments fail, your doctor may recommend surgery. The goal of surgery is to move or remove the source of the compression. In some people, this may involve removing part or all of the first rib to make more room for the nerves and blood vessels.
There are no current guidelines to prevent TOS.
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Last reviewed July 2013 by Rimas Lukas, MD; Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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