The thoracic outlet syndrome (TOS) is a group of disorders characterized by nerve compression and blood vessel compression in the area between the base of the neck and the armpits. The purpose of this article is to provide a straightforward overview of thoracic outlet syndrome's causes, symptoms, diagnosis, treatment, and prevention.
There are several factors that can cause thoracic outlet syndrome, including:
TOS can be caused by structural abnormalities such as extra ribs, tight muscles, or bony abnormalities in the thoracic outlet region.
Muscle imbalances and postural changes can result from prolonged sitting, slouching, or repetitive overhead activities.
Injuries such as whiplash, shoulder dislocation, or fractures can damage structures in the thoracic outlet and increase TOS risk.
Performing repetitive activities like overhead reaching, lifting heavy objects, or carrying backpacks can weaken the muscles and tissues in the thoracic outlet area and exacerbate TOS symptoms.
During pregnancy, hormonal changes, weight gain, and postural changes can increase pressure on the nerves and blood vessels in the thoracic outlet.
Symptoms of thoracic outlet syndrome vary depending on the structures involved and the severity of compression, but can include:
A dull, aching pain in the shoulder, neck, or upper back, often aggravated by overhead activities or prolonged sitting.
An arm, hand, or finger that feels numb, tingly, or pins and needles, especially after prolonged use or when the arm is elevated.
The ability to lift or grip objects is hindered by muscle weakness or fatigue in the arm, hand, or fingers.
Inflammation of the arm or hand, especially after exertion or prolonged use.
Feelings of coldness or changes in skin temperature in the affected arm or hand.
A reduction in blood flow to the arm or hand results in pale or bluish discoloration, slow wound healing, or reduced pulse intensity.
Thoracic outlet syndrome is typically diagnosed based on a combination of clinical evaluation, medical history, and diagnostic tests. Diagnostic procedures may include:
A healthcare provider will perform a thorough physical examination, assessing posture, range of motion, muscle strength, and sensation in the affected arm and shoulder.
To reproduce symptoms and assess for nerve or vessel compression in the thoracic outlet, provocative maneuvers such as Adson's maneuver, Roos test, or Wright test may be performed.
Studies such as X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans may be used to visualize the structures in the thoracic outlet, assess for anatomical abnormalities, and rule out other problems.
Thoracic outlet syndrome is treated by relieving symptoms, improving function, and preventing recurrence.
By exercising, stretching, and using manual therapy techniques under the supervision of a physical therapist, you can improve posture, muscle strength, and flexibility, reduce nerve compression, and alleviate symptoms.
Modifying posture, maintaining proper posture, and using ergonomic adjustments in daily activities can reduce strain on the thoracic outlet.
For pain, inflammation, or nerve-related symptoms associated with TOS, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or nerve pain medications may be prescribed.
A corticosteroid injection or local anesthetic injection may be administered to relieve pain and inflammation.
In cases of severe or refractory TOS, surgical intervention such as decompression of the thoracic outlet or removal of the first rib may be considered to relieve nerve or vessel compression.
Individuals can take steps to reduce the risk of developing or exacerbating thoracic outlet syndrome symptoms, such as:
Keeping a good posture, avoiding slouching, and using ergonomic support in sitting and standing positions can help reduce strain on the thoracic outlet.
Taking breaks, alternating tasks, and avoiding repetitive overhead activities can prevent muscle fatigue and reduce TOS symptoms.
Exercising the neck, shoulders, and upper back can improve posture, muscle balance, and stability in the thoracic outlet.
Use ergonomic equipment such as adjustable chairs, desks, and keyboard trays to optimize workstation setup and reduce neck, shoulder, and arm strain.
