What Is Thoracic Outlet Syndrome?
Thoracic outlet syndrome (TOS) is when you have pain, swelling, or other symptoms from compression in your thoracic outlet which is the opening between your lower neck and upper chest. It can trigger feeling numb and tingling in your arms or pain in your shoulders, specifically when you raise your arms.
The thoracic outlet is the narrow space in between your collarbone and top rib. Muscles run through it from your neck to your shoulder, together with the nerves and blood vessels that go down your arm. When something presses on them, you can have discomfort and other symptoms.
Thoracic Outlet Syndrome Types
There are 3 kinds of thoracic outlet syndrome:Neurogenic: Affects nerves leading from the spinal cord to the neck to the arm. Many thoracic outlet syndrome cases include nerves. Venous: Affects veins Arterial: Affects arteries
About 95% of thoracic outlet syndrome cases involve nerves.
It's rare but more serious when it affects a vein or an artery.
The condition is more common in women. It's also often seen in professional athletes and workers who make repeated arm movements. But it can impact anybody.
Thoracic Outlet Syndrome Symptoms
You're more than likely to feel them in your arms and hands. They include:
Nuisance, shoulder, or arm
Pins and needles and tingling
Discoloration-- blue, red, or pale
Atrophy (when the tissue or muscle in your arm starts to waste away) .
Weak pulse in your impacted arm.
Unpleasant swelling near your collarbone.
Diminishing of the muscle in the fleshy base of your thumb (also called Gilliatt-Sumner hand).
Thoracic Outlet Syndrome Causes and Risk Factors
There are several causes:.
Injuries: Whiplash, a damaged collarbone, or other injury can leave scar tissue and swelling.
Poor posture: When your shoulders slump, your collarbones can move out of location and press on your nerves. Weak shoulder muscles can trigger bad posture.
Repeated stress: It can affect people who move their arms in a particular way over and over again.
Physical problems: Some people are born with an extra rib or a thoracic outlet that's smaller than typical.
Weight problems: Extra weight can put tension on the muscles that support your collarbones.
Pregnancy: TOS can take place as your joints begin to get looser.
Growths, specifically in your upper chest or under your arm.
Stress or depression.
TOS is discovered more often in women than in men and mainly in young people, mostly ages 20-40.
Professional athletes who move their arms in the very same way a lot, like swimmers or baseball pitchers, likewise can be most likely to have it.
Thoracic Outlet Syndrome Diagnosis
Your medical professional will begin by asking questions to get an in-depth history of your signs and then do a physical examination.
Neurogenic: This type isn't always simple to diagnose. Things can compress the nerves that serve your arms and hands in different locations for a range of factors. The symptoms will be the exact same, however the problem might be arthritis in your neck, a pinched nerve, or carpal tunnel syndrome. Other conditions like a damaged rotator cuff, fibromyalgia, and multiple sclerosis can cause discomfort and numbness in your shoulders and arms. Another example is thinning or wasting of the muscle at the base of the thumb. This can happen with carpal tunnel syndrome too.
Venous and arterial: These symptoms are more obvious. Blood does not circulate properly. You may even have an embolism. Your arm or hand might be swollen, and look either pale or bluish. You could have a weak pulse or no pulse in the affected arm.
Several kinds of tests can assist with the medical diagnosis:.
Positioning tests: The medical professional will move your arms and head in various ways to see if the signs appear. One shortfall: These tests can also trigger symptoms in healthy people.
Scalene muscle block: The medical professional will provide you a shot that relaxes muscles in this area to see if that makes the symptoms go away.
Imaging tests: An X-ray, CT scan, or MRI can reveal an extra rib or other unusual physical feature. An ultrasound can look for blockages or narrowing of blood vessels.
Nerve tests: Results are generally normal in people with this condition, but they can eliminate other causes.
Blood flow tests: An arteriogram or venogram (tests that utilize dyes and X-rays to see how blood streams in your system) can reveal an embolism or other damage to blood vessels.
Thoracic Outlet Syndrome Treatment and Home Remedies
Management of TOS depends on the type.
Neurogenic: The common treatments are:.
Physical treatment: You'll do exercises to extend and enhance muscles in your neck and shoulders and enhance your posture. This may be all you need to get relief.
Medication: The doctor could suggest that you use a muscle relaxant or that you take ibuprofen or naproxen to ease pain and swelling. You might hear your physician call these NSAIDS, or non-steroidal anti-inflammatory drugs.
Botox shots: A shot into the muscle at the base of your neck can relax the location and help relieve pain. This can work for approximately 3 months and be repeated if you need it.
Surgery is sometimes a choice, but it does not work as well for this sort of TOS.
Venous and arterial: First you'll be treated for any possible embolism. Then you'll more than likely require a type of surgery called thoracic outlet decompression. Your surgeon will open the space for the nerves and blood vessels to travel through. They could eliminate extra bone or other tissue, and cut or eliminate muscles that are triggering the compression. They'll also fix or bypass harmed blood vessels.
If other treatments do not repair your symptoms, you may need long-term pain management. You may need medication. .
Your doctor likewise might advise a few things you can do to feel better:.
Get to a healthy weight.
Set up your workstation to support excellent posture. .
Avoid things that exacerbate the condition, like carrying a heavy bag on your shoulder.
Take breaks often at work to move and stretch.
Try a massage or a heating pad on your muscles.
Do relaxation exercises, like visualization, autogenic relaxation (duplicating a word that provides you peace), or progressive muscle relaxation (clinching then releasing different muscles). .
Thoracic Outlet Syndrome Complications
TOS should be dealt with as soon as possible. If it's not, it can lead to more major problems, like:.
Discomfort and swelling in your arm that does not go away .
Blood flow problems, like gangrene (the loss of body tissue) or ischemic ulcers (open sores on your fingers) .
Blood clots, which can trigger an extremely serious condition called pulmonary embolism (when a clot blocks a blood vessel in one of your lungs).