Thoracic Outlet Syndrome

The thoracic outlet is the area of the body between the collarbone and the rib cage. Veins, nerves, and arteries come through this opening. When the blood vessels or nerves are compressed or squeezed, the pressure causes the symptoms of thoracic outlet syndrome.

Symptoms of thoracic outlet syndrome can include:

• shoulder pain that increases in certain positions
• arm pain
• hand pain, especially in the ring finger and little finger
• weakness, numbness, or coldness in the arm
• vein distention in the hands
• decreased movement of the shoulder and arm
• limpness in the arm and shoulder
• tingling of arms, hands, shoulders, or neck
• swelling of fingers and hands
• dizziness
• an unusual sensation in the face
• headaches
• Raynaud's phenomenon, a condition causing pain, tingling, and color change in the fingers and toes when exposed to cold
• damage to and death of the tissues
• low blood pressure
• absence or decrease of a pulse in the arm

Causes of thoracic outlet may include:

• injury to the area of the collarbone or upper ribs
• spinal problems, such as a herniated disk that may compress the nerves
• bony protrusions on the spinal column near the thoracic outlet
• an extra rib or other abnormality present at birth
• pregnancy
• repetitive stress injury from activities that may compress the nerves, arteries, or veins

Sometimes a cause cannot be identified.

Although thoracic outlet syndrome cannot always be prevented, the following measures may help:

• good posture
• strengthening exercises for the muscles in and near the thoracic outlet
• proper technique for repetitive heavy lifting

Thoracic outlet syndrome can sometimes be diagnosed by a history and physical exam. In many cases, however, the symptoms are vague and difficult to track down. A chest x-ray may show an extra rib. A nerve conduction velocity test can measure abnormal nerve transmission in the arm. Doppler studies may also be done to check the blood flow through the outlet. Other special tests may be done to check whether the blood vessels beside the nerve are being pinched. Many times all of these tests are negative. In these cases, the history and physical exam is used to make the diagnosis.

Other tests may be ordered to rule out problems such as neck injuries. This may include x-rays or an MRI scan of the neck.

If physical therapy, exercises, and good posture reduce the symptoms, then the outlook is good. If symptoms do not go away, then surgery may be needed.

Thoracic outlet syndrome is not contagious and poses no risk to others.

Treatment of thoracic outlet syndrome focuses on relief of the symptoms caused by compression of the nerves and blood vessels. A person may need physical therapy as well as exercises to strengthen the muscles of the shoulder, neck, and upper arm. Practicing good posture and good work habits may also reduce symptoms. This includes learning the proper way to sit, type, and talk on the phone.

Over-the-counter anti-inflammatory medication or prescription pain medication may also be needed. Surgery may be needed to remove the first rib or restructure the muscles of the thoracic outlet.

Side effects will depend on the treatment used. Medications can cause stomach upset, rash, or an allergic reaction. Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.

A person may have to continue exercises as long as he or she has symptoms. If a person has surgery, then physical therapy may be needed to strengthen the muscles of the shoulder and arm. A person may be limited on range of motion, heavy lifting, and strenuous exercise while recovering from surgery.

A person can monitor symptoms based on the intensity of pain, weakness, and ability to move the arm and shoulder. Any new or worsening symptoms should be reported to the healthcare professional.