Thoracic Outlet Syndrome (TOS) refers to a cluster of conditions that arise when the nerves and/or blood vessels in the thoracic outlet – the area between the lower neck and upper chest i.e. extending from the collar bone up to the first rib, are compressed. TOS is characterised by incessant pain in the neck, shoulders, weakness in the arms, tingling sensations and aching in the hands, such as in piriformis syndrome wherein the sciatic nerve is compressed triggering low back pain and soreness in the legs, thighs and feet.
Thoracic outlet syndrome can develop in men and women of all age groups but predominantly occurs in middle-aged women owing to hampered development of muscles or poor posture. Furthermore, athletes and sportspersons who engage their arms and shoulders in repetitive vigorous movements, like in swimming, tennis, volleyball etc. are also predisposed to acquiring TOS.
Types Of Thoracic Outlet Syndrome:
There are many different categories of TOS, with the three foremost kinds being:
Neurogenic/Neurological Thoracic Outlet Syndrome: This is the most common type of TOS, in which a bunch of nerves stemming from the spinal cord known as brachial plexus, which coordinate the motion of the shoulders, arms, hands, are compressed.
Vascular Thoracic Outlet Syndrome: This form of TOS happens when either the veins (venous thoracic outlet syndrome) or arteries (arterial thoracic outlet syndrome) located beneath the collar bone i.e. clavicle are compacted.
Non-Specific Thoracic Outlet Syndrome: When the cause of discomfort in the body cannot be determined but pain persists in the thoracic outlet during and immediately after physical activity, it is termed as non-specific thoracic outlet syndrome.
Several factors induce thoracic outlet syndrome, such as structural abnormalities in the cervical rib or spinal cord present right from birth i.e. congenital defects, bad posture with hunching and drooping of shoulders, head, besides carrying heavy loads on the shoulders like bags/backpacks and surplus bodyweight like in obesity.
Additionally, trauma from an accident, unwinding of joints during pregnancy and constant brisk motions of the neck, shoulders, arms while playing sports also prompt thoracic outlet syndrome.
The distinguishing signs of neurological thoracic outlet syndrome consist of:
- Numb feeling in the forearms and hands
- Lack of strong grip
- Deterioration of muscle tissues at the fleshy base of the thumb
- Intense pain in the neck, arms, as well as the shoulders like in shoulder bursitis
Vascular thoracic outlet syndrome exhibits quite a few distinctive indications, such as:
- Formation of blood clots in the upper portion of the body near the thoracic outlet
- Weak pulse in the arm due to obstruction of blood vessels
- Swollen lump in the vicinity of the collarbone
- Pain, inflammation, unusual cold feeling, loss of sensation and fatigue in the arms and hands
- Prominent discolouration of the hand, with a purple to blue colour, like in Raynaud’s disease
Since the nature of symptoms and the intensity of pain and numbness varies from one patient to another, thoracic outlet syndrome is rather challenging to detect. The doctor initially assesses the external signs of the patient by means of a thorough physical examination, to spot any irregularities in the shoulders, collarbone, neck, arms and hands and gauge if there are any problems in the movement of these muscles and joints. The medical history of the patient is also recorded, to assess if any traumatic incidents like a car or bike accident might have triggered TOS.
The instance of thoracic outlet syndrome is then confirmed by imaging tests, which comprise X-ray, CT scans, ultrasound analyses, MRI scans, besides an EMG i.e. electromyography, to determine the electrical conduction of muscles in the neck, arms and shoulders.
Treating thoracic outlet syndrome in the early stages entails physical therapy sessions, with exercises and stretches to actively engage the neck, shoulders and arms, apart from prescription anti-inflammatory medications to relieve pain and potent drugs to eliminate blood clots and prevent further coagulation in the area of the compressed blood vessels and nerves. Simple home remedies such as cultivating a proper posture maintaining an erect spine with the shoulders and neck in alignment, avoiding lifting heavy weights and bags and using heating pads or cold compresses on the affected regions help lessen pain and discomfort.
However, if physical therapy and medications do not decrease inflammation in the thoracic cavity, then the healthcare provider recommends surgery. Surgical methods involve a procedure known as thoracic cavity decompression, wherein the medical expert operates on the affected nerves, blood vessels, to expose and repair the compacted tissues, which aids in reducing pain in the neck, arms and shoulders.