Thoracic Outlet Syndrome
Thoracic outlet syndrome is uncommon. It can occur when the nerves and blood vessels coming from the spine or a major vessel of your body pass through a narrow space between the shoulder and armpit continuing down the arm.
As the blood vessels and nerves pass the collarbone and upper ribs, there may not be enough space, which can cause pressure (compression). Pressure on the nerves and vessels cause pain in the neck, shoulder, armpit, hand and lead to a weak grip.
Another cause of the compression can stem from having an extra cervical rib or an abnormal fibrous band between the spinal vertebra connecting to the rib. Patients with injuries to a shoulder or who overuse a shoulder are most affected with TOS.
Symptoms can include:
- Aching in your neck, shoulder, arm or hand
- Pain, numbness or tingling of your forearm or fingers
- Hand weakness
- Limited range of motion of your arm
- A depression in your shoulder
- Pain in your neck muscles
- Swelling and redness of your arm
- Pale and cool arm and hand
- Having an extra rib at birth
- An abnormality in the neck muscles at birth
- Neck injury
- Injury to the first rib or collarbone
- Repetitive overhead arm movements that may cause inflammatory changes
TOS diagnosis and tests
- A physical exam by a vascular surgeon that includes a detailed history.
Once your physician has diagnosed thoracic outlet syndrome, physical therapy and/or surgery may be recommended. The types of surgery that are performed to correct TOS are:
- Removal of the extra rib and some muscles
- Removal of a section of the first rib to relieve pressure
- Bypass surgery, to reroute the blood