Ongoing discomfort and numbness in the neck, arms, or hands isn’t normal.
In my practice, I see a range of people from young athletes to older folks with these symptoms, and they are often surprised to learn that they may have thoracic outlet syndrome (TOS). Here’s what you should know about this uncommon condition and who’s at risk.
What is thoracic outlet syndrome?
The triangle-shaped area between the collarbone and top rib is called the thoracic outlet. When nerves and blood vessels in this area become pinched and compressed, that’s TOS. Most of the time, it’s nerves getting pinched. But sometimes, it’s the main vein or artery to the arm getting pinched, which increases the risk of blood clots in the area.
What are thoracic outlet syndrome symptoms?
I see patients with a variety of TOS symptoms. The signs can include:
- Vague, aching pain in the neck, shoulder, arm, or hand
- Numbness, tingling, and pain in the pinky and ring fingers and inner forearm
- Signs of poor circulation in the hand or forearm, such as a bluish color, swelling, or a cold hand
- Weakness in the hand muscles that might feel like being tired or clumsy
- Sores on the fingers that are slow to heal
- Limited range of motion
It’s common for TOS pain to get worse when you lift the affected arm.
What causes thoracic outlet syndrome, and who’s at risk?
TOS can be caused by congenital problems from birth, injury, disease, or overuse. Examples include:
- An extra rib or an abnormally tight band connecting the spine to the ribs
- Injuries from car accidents or falls
- Functional issues and repetitive shoulder motions of baseball players, swimmers and weightlifters or those with jobs requiring overhead lifting like painters, hair stylists, or barbers
Anyone can develop TOS. But more women than men have TOS. People who lift weights regularly, carry heavy shoulder loads, or have tumors or large lymph nodes in the upper chest or armpit have a higher risk. And poor posture and obesity can also make the condition worse.
How is thoracic outlet syndrome diagnosed?
Identifying TOS typically requires several tests. One you can try at home is the elevated arm stress test: Raise both arms over your head, then open and close your firsts for about three minutes. If this exercise reproduces your symptoms, it’s a sign that TOS may be at play. This test is one of many that help with diagnosing TOS. Your doctor will use many tests to evaluate for other conditions that give similar symptoms like cervical spine issues, shoulder problems and neurologic disorders.
Tests like x-ray, CT scan, MRI, and ultrasound can help us evaluate muscles, bones, tendons, and blood vessels. Nerve conduction tests and blood circulation tests can also help us reach an accurate diagnosis.
When is TOS an emergency?
TOS can reduce blood flow to the arm or cause blood clots in the artery or vein of the arm. If there is any sudden change of warmth, color or function of the arm, you should seek immediate attention. Steps to diagnose and treat these serious symptoms should be completed within a health system with expertise in TOS.
What is the treatment for thoracic outlet syndrome?
Most people can reduce their symptoms without surgery:
- Physical therapy can strengthen core muscles of the neck and chest, shoulders and arms, as well as improve posture.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can reduce swelling and ease discomfort.
- Weight loss can reduce the stress on the shoulder muscles that support the collarbone.
- Lifestyle changes, like modifying your workstation, can help you function more comfortably.
- A specialized injection of the muscles involved with TOS can provide temporary relief. This is offered at Temple University Hospital
If nonsurgical treatment doesn’t provide relief, decompression surgery may be needed. Each TOS procedure is different. It may involve removing a portion of an abnormal rib, releasing a muscle that connects the neck and chest, or both. There are many approaches to this operation, including an incision near the collar bone or in the armpit. However, the robotic approach is the state-of-the-art technique that offers the most complete removal of the offending rib and safe recovery.
Where can I get help?
The thoracic outlet is a hub of activity in the body. That’s why if you suspect you have TOS, you should seek care from experts.
At Temple Health, our Thoracic Outlet Syndrome Center specializes in the diagnosis and treatment of TOS. Our multidisciplinary team collaborates to address this complex condition. We are with you from diagnosis through treatment and beyond.
Your path to healing starts here. Call 800-TEMPLE-MED (800-836-7536) or schedule an appointment online.