This group of disorders causes symptoms including pain or numbness due to pressure on the blood vessels or nerves between the collarbone and rib.
Thoracic outlet syndrome (TOS) is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause shoulder and neck pain and numbness in your fingers.
Common causes of thoracic outlet syndrome include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects (such as having an extra rib), and pregnancy. Sometimes doctors don't know the cause of thoracic outlet syndrome.
Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures. Most people improve with these treatments. In some cases, however, your doctor may recommend surgery.
The thoracic outlet is the space between your collarbone (clavicle) and your first rib. This narrow passageway is crowded with blood vessels, nerves and muscles.
There are three general types of thoracic outlet syndrome:
It's possible to have a mix of the three different types of thoracic outlet syndrome, with multiple parts of the thoracic outlet being compressed.
Thoracic outlet syndrome symptoms can vary depending on the type. When nerves are compressed, signs and symptoms of neurogenic thoracic outlet syndrome include:
Signs and symptoms of venous thoracic outlet syndrome can include:
Signs and symptoms of arterial thoracic outlet syndrome can include:
See your doctor if you consistently experience any of the signs and symptoms of thoracic outlet syndrome.
Thoracic outlet syndrome is usually caused by compression of the nerves or blood vessels in the thoracic outlet, just under your collarbone (clavicle). The cause of the compression varies and can include:
There are several factors that seem to increase the risk of thoracic outlet syndrome, including:
Complications from this condition stem from the type of presentation (neurogenic, venous or arterial). For patients with venous or arterial TOS, it is important to seek urgent medical attention to make the correct diagnosis and implement appropriate treatment. For neurogenic TOS, it is important to seek medical attention with appropriate evaluation and testing.
If you're at risk for thoracic outlet compression, avoid repetitive movements and lifting heavy objects. If you're overweight, losing weight may help you prevent or relieve symptoms of thoracic outlet syndrome.
Even if you don't have symptoms of thoracic outlet syndrome, avoid carrying heavy bags over your shoulder, because this can increase pressure on the thoracic outlet. Stretch daily, and perform exercises that keep your shoulder muscles strong.
Daily stretches focusing on the chest, neck and shoulders can help improve shoulder muscle strength and prevent thoracic outlet syndrome.
Diagnosing thoracic outlet syndrome can be difficult because the symptoms and their severity can vary greatly among people with the disorder. To diagnose thoracic outlet syndrome, your doctor may review your symptoms and medical history and conduct a physical examination and additional imaging and testing.
To confirm the diagnosis of thoracic outlet syndrome, your doctor may order one or more of the following tests:
Arteriography and venography. In these tests, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin. The catheter is moved through your major arteries in arteriography, or through your veins in venography, to the affected blood vessels. Then your doctor injects a dye through the catheter to show X-ray images of your arteries or veins.
Doctors can check to see if you have a compressed vein or artery. If a vein or artery has a clot, doctors can deliver medications through the catheter to dissolve the clot.
In most cases, a conservative approach to treatment may be most effective, especially if your condition is diagnosed early. Treatment may include:
Your doctor may recommend surgery if conservative treatments haven't been effective, if you're experiencing ongoing or worsening symptoms, or if you have progressive neurological problems.
A surgeon trained in chest (thoracic) surgery or blood vessel (vascular) surgery will perform the procedure.
Thoracic outlet syndrome surgery has risks of complications, such as injury to the brachial plexus. Also, surgery may not relieve your symptoms, and symptoms may recur.
Surgery to treat thoracic outlet syndrome, called thoracic outlet decompression, may be performed using several different approaches. These approaches involve removing a muscle and a portion of the first rib to relieve compression. You may also need surgery to repair compressed blood vessels.
In venous or arterial thoracic outlet syndrome, your surgeon may deliver medications to dissolve blood clots prior to thoracic outlet compression. Also, in some cases, your surgeon may conduct a procedure to remove a clot from the vein or artery or repair the vein or artery prior to thoracic outlet decompression.
If you have arterial thoracic outlet syndrome, your surgeon may need to replace the damaged artery with a section of an artery from another part of your body (graft) or an artificial graft. This procedure may be done at the same time as your procedure to have the first rib removed.
If you're diagnosed with thoracic outlet syndrome, your doctor or physical therapist will instruct you to do exercises at home to strengthen and support the muscles surrounding your thoracic outlet.
In general, to avoid unnecessary stress on your shoulders and muscles surrounding the thoracic outlet:
Symptoms associated with thoracic outlet syndrome can be caused by a number of other conditions, which makes it difficult for doctors to diagnose the condition. Many people experience thoracic outlet syndrome symptoms for years before they are diagnosed with the condition, which can cause stress and frustration. Be sure to discuss your concerns with your doctor if your symptoms persist and a diagnosis hasn't been made.
You're likely to start by seeing your primary care doctor. In some cases, your doctor may refer you to a doctor trained in blood vessel (vascular) conditions or blood vessel surgery.
Here's some information to help you prepare for your appointment.
Preparing a list of questions will help you make the most of your time with your doctor. For thoracic outlet syndrome, some basic questions to ask your doctor include:
Don't hesitate to ask any other questions you have.
Your doctor is likely to ask you a number of questions, such as:
While you're waiting for your appointment, try taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin IB, others). Your discomfort may also be improved if you maintain good posture and avoid using repetitive movements and lifting heavy objects.