Thoracic Outlet Syndrome

What is TOS?

Thoracic Outlet Syndrome (TOS) is a group of disorders that affect the nerves in the brachial plexus (nerves that pass into the arms from the neck) and various nerves and blood vessels between the base of the neck and axilla (armpit). A syndrome is defined as a group of signs and symptoms that collectively characterize or indicate a particular disease or abnormal condition.

TOS gets its name from the space (the thoracic outlet) between your collarbone (clavicle) and your first rib. This narrow passageway is crowded with blood vessels, muscles, and nerves. If the shoulder muscles in your chest are not strong enough to hold the collarbone in place, it can slip down and forward, putting pressure on the nerves and blood vessels that lie under it. Symptoms vary, depending on which structures (nerves or blood vessels) are being compressed. Pressure on the blood vessels can reduce the flow of blood to your arms and hands, making them feel cool and tire easily. Pressure on the nerves can leave you with a vague, aching pain in your neck, shoulder, arm or hand. Overhead activities are particularly difficult.

A variety of other signs / symptoms that may be confused with TOS including carpal tunnel syndrome, cervical spine disease with nerve root compression, tumors of the spinal cord or brachial plexus, as well as a variety of other neuromuscular disorders.

TOS can result from injury, disease, or a congenital abnormality. Psychological changes are often seen in patients with thoracic outlet syndrome. It is not clear whether these precede the onset of the syndrome or are the result of dealing with the pain and frustration of diagnosing and treating this condition.

Signs and Symptoms of TOS

Vascular Symptoms Include:

1. Swelling or puffiness in the arm or hand;
   
   
2. Bluish discoloration in the arm or hand;
   
   
3. Feeling of heaviness in the arm or hand;
   
   
4. Pulsating lump above the clavicle (collarbone)
   
   
5. Deep, boring toothache-like pain in the neck and shoulder region, which seems to increase at night;
   
   
6. Easily fatigued arms and hands; and
   
   
7. Superficial vein distention in the hand.

Neurological Symptoms Include:

1. Parasthesia along the inside forearm and the palm (C8, T1 dermatome);
   
   
2. Muscle Weakness and atrophy of the gripping muscles and small muscles of the hand;
   
   
3. Difficulty with fine motor tasks of the hand;
   
   
4. Cramps of the muscles on the inner forearm
   
   
5. Pain in the arm and hand; and
   
   
6. Tingling and numbness in the neck, shoulder region, arm and hand.
   
   

Treatment for TOS

• Physical therapy can help strengthen the muscles surrounding the shoulder so that they are better able to support the collarbone.
  
  
• Postural exercises can help you stand and sit straighter, which lessens the pressure on the nerves and blood vessels.
  
  
• Nonsteroidal anti-inflammatory drugs, like aspirin or ibuprofen, can ease the pain.
  
  
• You may need to change your workstation and avoid strenuous activities.
  
  
• In some cases, surgery may be recommended if conservative treatment fails. The surgery involves dividing a muscle in the neck and removing a portion of the first rib.

If you are suffering from Thoracic Outlet Syndrome as the result of an injury, and would like to work with a dedicated personal injury attorney who cares about your case, contact Belt Law Firm. Call us toll free at 1-888-933-1514 for your free consultation.

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