This group of conditions is caused by pressure on the blood vessels or nerves between the collarbone and rib. The pressure can cause pain and numbness.
Thoracic outlet syndrome (TOS) is a group of conditions in which there's pressure on blood vessels or nerves in the area between the neck and shoulder. This space is known as the thoracic outlet. Compression of the blood vessels and nerves can cause shoulder and neck pain. It also can cause numbness in the fingers.
Common causes of thoracic outlet syndrome include trauma from a car accident, repetitive injuries from a job or sport, and pregnancy. Differences in anatomy, such as having an extra or irregular rib, also can cause TOS. Sometimes the cause of thoracic outlet syndrome is not known.
Treatment often involves physical therapy and pain relief. Most people improve with these treatments. For some, surgery may be recommended.
The thoracic outlet is the space between the collarbone, known as the clavicle, and the first rib. This narrow passageway is crowded with blood vessels, nerves and muscles.
There are three types of thoracic outlet syndrome:
Thoracic outlet syndrome symptoms can vary depending on the type. When nerves are compressed, symptoms of neurogenic thoracic outlet syndrome include:
Symptoms of venous thoracic outlet syndrome can include:
Symptoms of arterial thoracic outlet syndrome can include:
See your healthcare professional if you regularly experience any of the symptoms of thoracic outlet syndrome.
Thoracic outlet syndrome is often caused by compression of the nerves or blood vessels in the thoracic outlet, the area between the neck and shoulder. 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 thoracic outlet syndrome. If you have swelling or a painful discoloration in the arm, it is important to seek urgent medical attention. You may need treatment for blood clots or an aneurysm.
For neurogenic TOS, repetitive nerve compression can result in long-term injury resulting in chronic pain or disability. Neurogenic TOS can be confused for other joint or muscle injuries. If symptoms don't improve, it is important to seek medical attention for an evaluation and testing.
If you're at risk of 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. This can increase pressure on the thoracic outlet. Stretch daily, and do exercises that keep your shoulder muscles strong and flexible.
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 challenging. Symptoms can vary greatly among people. Your healthcare professional may review your symptoms and medical history and conduct a physical exam. You also may need imaging and other types of tests.
Physical exam. Your healthcare professional does a physical exam to look for signs of thoracic outlet syndrome. These may include a depression in your shoulder or a bony area above the collarbone. Your healthcare professional also may look for swelling or a change in color in your arm. You may need to have your pulse and your range of motion checked.
Your health professional may reproduce your symptoms by asking you to move or lift your arms or turn your head. Knowing which positions and movements trigger your symptoms can help identify thoracic outlet syndrome.
To confirm the diagnosis of thoracic outlet syndrome, you may need one or more of the following tests:
Arteriography and venography. In these tests, a thin, flexible tube called a catheter is inserted through a small cut, often in your groin. During arteriography, the catheter moves through your major arteries. During venography, the catheter moves through your veins. The catheter is threaded to the affected blood vessels. Then a dye is injected to show X-ray images of your arteries or veins.
Healthcare professionals 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.
A conservative approach to treatment may be effective for most people, especially if your condition is diagnosed early. Treatment may include:
Your healthcare professional may recommend surgery if conservative treatments haven't been effective. Or you might consider surgery if you experience ongoing or worsening symptoms.
A surgeon trained in chest surgery, known as a thoracic surgeon, or blood vessel surgery, known as a vascular surgeon, typically does the procedure.
Thoracic outlet syndrome surgery has risks of complications, such as injury to the nerves, known as the brachial plexus. Also, surgery may not relieve your symptoms or only partially relieve your symptoms, and symptoms may come back.
Surgery to treat thoracic outlet syndrome, called thoracic outlet decompression, may be done using several different approaches. These approaches involve removing a muscle and a part of the first rib to relieve compression. You also may need surgery to repair damaged blood vessels.
In venous or arterial thoracic outlet syndrome, your surgeon may deliver medicines to dissolve blood clots prior to thoracic outlet decompression. Or you may need a procedure to remove a clot from the vein or artery or to repair the vein or artery. The procedure is done before thoracic outlet decompression.
If you have arterial thoracic outlet syndrome, your surgeon may need to replace the damaged artery. This is done with a section of an artery from another part of your body, known as a graft. Or an artificial graft may be used. This procedure may be done at the same time as a procedure to have the first rib removed.
If you're diagnosed with thoracic outlet syndrome, a physical therapist may instruct you to do exercises at home. The exercises can 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. This can make it hard to diagnose. Many people experience thoracic outlet syndrome symptoms for years before they are diagnosed with the condition. Discuss your concerns with your healthcare professional if your symptoms persist and a diagnosis hasn't been made.
You're likely to start by seeing your healthcare professional. Or you may be referred to a doctor trained in blood vessel conditions or in blood vessel surgery, known as a vascular surgeon.
Here's some information to help you prepare for your appointment.
Preparing a list of questions helps you make the most of your time. For thoracic outlet syndrome, some basic questions to ask include:
Don't hesitate to ask any other questions you have.
It's likely you'll be asked several 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 also may be improved if you maintain good posture and avoid using repetitive movements and lifting heavy objects.