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Thoracic Outlet Syndrome
Once treated, ideally by combining medical treatment with physical therapy, you should be able to return to an active lifestyle
Overview
Thoracic Outlet Syndrome is a group of conditions that result from the compression of the nerves or blood vessels in your arm. This usually affect those who are otherwise health, young, and active. There are different types of TOS: Neurogenic which occurs when the nerves leading from the neck to the arm are compressed (90%+ of cases), Venous which occurs when a vein is compressed leading to upper body thrombosis (5% of cases), or Arterial which occurs when an artery is compressed (1% of cases). Sometimes the venous and arterial syndromes are known together as vascular thoracic outlet syndrome.
Symptoms
Some common symptoms of Thoracic Outlet Syndrome are...
Pain, Numbness, or Tingling in your Neck, Arms and Hands
Swelling, Blue Discoloration, Fatigue in your Arms and Hands
Sores on Hands that Resist Healing
Causes
TOS occurs when there is a compression of nerves, the subclavian artery, or subclavian vein on the side of the throat or upper chest. This may also occur due to an injury of the artery due to an abnormality in a neck rib or other bony irritation, or even an injury or compression of the vein which leads to its progressive narrowing and eventual clot formation. Some potential risk factors are...
Whiplash
Cervical Rib
Weight Gain
Body Building
Abnormal Muscle or First Rib Formation
Repeated Overhead Motions
A Tumor in the Neck
Diagnosis
Several types of tests are used to diagnose TOS and to determine the best course of treatment. Your Vascular Specialist may recommend a CT scan, a MRI, a catheter-based arteriography or venogram, or stress maneuver testing (where the arm or head are placed in certain positions). During the diagnostic period, your vascular specialist may recommend an anesthetic block injection as they can temporarily improve symptoms and aid in diagnosis.
Treatment
The best treatment outcomes come from a combination of medical treatment and physical therapy. Your specific treatment plan will vary depending on the source of the condition. If it is nerve-related, specialized physical therapy and injections are typically used to resolve your symptoms. If symptoms are severe and persist, you may be recommended surgery, specifically a procedure called thoracic outlet decompression. If surgery is not suitable for you, or symptoms continue to persist post-surgery, then you will want to consider ongoing medication to manage pain. If your condition is artery-related, the thoracic outlet decompression surgery is recommended. Depending on the damage to the artery, an arterial bypass may be recommended as well. If your condition is vein-related, then it may depend. If your arm is swelling or a blood clot is present in the vein due to thoracic outlet compression, then the thoracic outlet decompression surgery is recommended. If there is a clot in the vein, you may be directed to have thrombolytic therapy. You may also be directed towards some type of vein reconstruction: angioplasty, patch angioplasty, or venous bypass.
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Visit Society of Vascular Surgery for more information.
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