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Thoracic Outlet Syndrome

Thoracic outlet syndrome is a condition where:

• blood vessels (veins and arteries) and/or
• nerves

that enter the arm from the neck nerve roots are squeezed/compressed due to narrowing of the thoracic outlet (space between collarbone and 1st rib).

This leads to:

• discomfort and pain
• tingling sensation
• numbness sensation

in the neck, shoulder, arm, elbow, forearm, hand and fingers of the blood vessels and nerves involved.

What are the causes thoracic outlet syndrome?

Unfortunately, it's still unclear to the medical community what is the specific cause. Generally what is agreed is that any health conditions or issues that leads/causes movement or enlargement of tissues near the thoracic outlet can narrow the thoracic outlet space and cause nerve/vessel compression.

Some examples include:

1. Repetitive strain and repetitive-mini-traumas such as repeated overhead movements, spending long time typing at keyboard/computer, lifting and keeping hands above head (eg holding mobile phone to watch show above head height), poor lifting techniques - these can strain neck and shoulder tissues and cause nerve and blood vessels compression
2. Poor sitting, standing or walking posture such as slouching, forward head position over time will cause increased strain on the neck muscles and may stretch the nerves in the neck
   
3. Birth anatomical defects eg born with extra rib at neck level or born with narrower thoracic outlet increases this risk
4. Increased muscle bulk at neck and shoulder from body building and weight lifting may increase the risk of thoracic outlet syndrome
   
5. Direct blows, hits, accidents and trauma such as sports collision, car accident or even falls can cause tissue changes to the thoracic outlet area
6. Being obese/overweight will increase fatty tissues in the neck that can compress the thoracic outlet

signs and symptoms of thoracic outlet syndrome

There is two main types of structures involved in thoracic outlet syndrome:

Type #1: Blood Vessels Only - Vascular Thoracic Outlet Syndrome

Veins and/or arteries in the thoracic outlet are compressed. Patients often report:

1. Feeling of heaviness, sluggishness, swelling in arms
2. An ache in the neck, shoulder and arm, sometimes described as "deep ache"
3. Arm and hand color becomes different from non-affected (more pale, blue-ish)
4. Finger(s) may be presented as pale
5. There may be a palpable lump/mass near the collarbone
   

Type #2: Nerves Only - Neurogenic/ Neurological Thoracic Outlet Syndrome

Nerves in the thoracic outlet are compressed; this is the most common cause of the syndrome. Patients often report experiencing:

1. Discomfort and pain in their shoulder and neck
2. Sensory loss or altered sensation in the arm and hand
3. Aching sensation in their arm and hand
4. Tingling from neck to shoulder to arm to forearm to hand to fingers, and it can be all or just in parts
5. Muscle weakness of the arm and hand, feeling hand is heavy, poor grip
   

treatment options of thoracic outlet syndrome

Patients who suffer from thoracic outlet syndrome are usually conservatively managed especially with early diagnosis with the following

Physiotherapy where patients will be treated with a variety of manual therapy including ranging, stretching and gliding exercises to improve joint range of motion, circulation and relieve compressive forces. We may also work on improving/correcting posture and return to work and life.

Pharmaceutical (medications) such as muscle relaxants to relax the muscles as well as anti-inflammation medicine to decrease pain experience and inflammation.

Only when thoracic outlet symptoms are progressively worsening or severe, then the treating physician may request patient to consider surgical intervention to remove the first rib (loosens up the thoracic outlet entirely).

Following surgical intervention, patients are required to undergo active physiotherapy to strengthen the muscles of the shoulder, chest, neck and arms to restore movement and function.

can thoracic outlet syndrome be prevented?

Unfortunately, as the medical community doesn't know the main causes of thoracic outlet syndrome, it's harder to prevent. It's even harder when the thoracic outlet syndrome is caused by inherited anatomical defects and other conditions.

That being said, risks for the development and deterioration of the syndrome can done with:

1. Losing weight if patient is overweight or obese
2. Avoid repetitive overhead activities eg sleeping with arm above the head, stocking shelves
3. Avoid carrying heavy weights and objects, and if need to, to employ good and safe lifting techniques
4. Improve standing and walking posture. Even better to apply good ergonomics and good working posture at work