Thoracic Outlet Syndrome – Causes, Symptoms and Treatment

TOS Facts 

• Thoracic Outlet Syndrome (TOS) affects approximately 8 out of every 100,000 individuals annually. 
• TOS typically affects individuals of ages 20 to 50, but it can occur in people of any age. 
• Roughly 95% of TOS cases are classified as neurogenic, resulting from compression of the brachial plexus neuropathy. 
• TOS accounts for about 1-2% of all vascular disorders. 
• Delayed diagnosis is common, with many patients experiencing symptoms for months or even years before receiving proper treatment. 

What is Thoracic Outlet Syndrome? 

Thoracic Outlet Syndrome is an umbrella term used for a range of rare conditions triggered by the compression or irritation of nerves and/or blood vessels within the thoracic outlet. Symptoms may include arm numbness, tingling, or shoulder pain, particularly during arm movement. 

Treatment typically encompasses physical therapy and pain management, which prove effective for the majority of individuals. TOS surgery may be advised for those who do not respond adequately to conservative measures. 

Anatomy of the Thoracic Outlet 

The thoracic outlet is a passage situated between the collarbone and the first rib. It accommodates the blood vessels, muscles, and nerves. If the shoulder muscles lack the strength to support the collarbone, it may descend and shift forward, applying pressure on the underlying nerves and blood vessels, leading to the array of symptoms characteristic of thoracic outlet syndrome. 

What are the different types of Thoracic Outlet Syndrome? 

Thoracic outlet syndrome manifests in three main types: 

• Neurogenic: Primarily impacting nerves extending from the spinal cord to the neck and arm, with the majority of cases involving nerve compression. 
• Venous: Affecting veins. 
• Arterial: Influencing arteries. 

Nerve-related cases constitute approximately 95% of thoracic outlet syndrome instances, with venous or arterial involvement being rarer yet more severe. While more prevalent among women, the syndrome is also observed in athletes and individuals with professions requiring repetitive arm movements, though it can affect anyone indiscriminately. 

What are the probable causes of Thoracic Outlet Syndrome? 

Thoracic outlet syndrome may stem from various factors, including: 

• Any injury 
• A disease 
• Any congenital issues like an abnormal first rib 

It is more prevalent among women than men, and factors like poor posture and obesity can exacerbate it. Patients with this syndrome often exhibit psychological changes, though it remains uncertain whether these changes precede or follow the syndrome’s onset. 

What are the symptoms of TOS? 

Thoracic outlet syndrome symptoms associated with thoracic outlet syndrome vary depending on its type: 

Neurogenic Thoracic Outlet Syndrome: 

• Shoulder and arm pain or weakness 
• Tingling or discomfort in the fingers 
• Quick arm fatigue 
• Rare instances of thumb pad muscle atrophy 
• Symptoms often exacerbate when arms are raised, with prolonged elevation worsening the discomfort. 

Venous Thoracic Outlet Syndrome: 

• Swelling (oedema) in the arm, hand, or fingers 
• Bluish discoloration of the hand and arm 
• Painful tingling sensations in the hand and arm 
• Prominent veins visible in the shoulder, neck, and hand 

These symptoms stem from vein compression leading to blood clot formation, a condition known as effort thrombosis or Paget-Schroetter syndrome, typically triggered by overhead movements that compress the vein. 

Arterial Thoracic Outlet Syndrome: 

• Cold and pale hand 
• Hand and arm pain, particularly during overhead arm motions 
• Arterial blockage (embolism) in the hand or arm 
• Subclavian artery aneurysm 

Thoracic Outlet Syndrome Treatment 

Non-surgical Approaches 

Physical Therapy 

• Physical Therapy sessions aim to provide strength to the muscles around the shoulder, providing better support for the collarbone. 

• Postural exercises encourage improved alignment while standing and sitting, alleviating pressure on nerves and blood vessels. 

Medications 

• NSAIDs: Nonsteroidal anti-inflammatory drugs are prescribed to alleviate pain and reduce inflammation. 
• Botox Shots: Botox injections may be administered into the muscle at the base of the neck to induce relaxation and pain relief, with effects lasting up to 3 months and repeatable if necessary. 

Changes in lifestyle 

• Weight Loss: Weight management strategies may be suggested, particularly for overweight individuals, to alleviate stress on the shoulder muscles supporting the collarbone. Moreover, lifestyle adjustments, such as reconfiguring workstations, avoiding strenuous activities, and modifying daily tasks that exacerbate symptoms, may also be recommended. 

Surgical Intervention 

If conservative treatments fail to alleviate symptoms, our thoracic specialist might suggest TOS surgery or minimally invasive thoracic surgery. Surgery, known as thoracic outlet decompression, employs various methods, such as removing a muscle and part of the first rib, to alleviate compression. Additionally, surgery may be necessary to repair damaged blood vessels. 

For venous or arterial thoracic outlet syndrome, your surgeon may administer medications to dissolve blood clots before thoracic outlet decompression. Alternatively, clot removal or vessel repair procedures may be required prior to decompression. 

In cases of arterial thoracic outlet syndrome, artery replacement using a graft from another part of the body or an artificial graft may be necessary. This procedure, often performed alongside first rib removal, aims to address the damaged artery. 

Besides thoracic decompression surgery, our doctor might suggest additional procedures to reconstruct the vein, such as: 

• Angioplasty and Stenting: Utilizing a catheter inside the vein to insert a stent, which keeps the vein open and may release medication to prevent clot formation. 
• Patch Angioplasty: Applying a synthetic patch over weakened sections of the vein to reinforce its structure. 
• Venous Bypass: Redirecting blood flow by connecting a synthetic tube or a segment of another blood vessel above and below the affected area of the vein. 

Seek the right line of thoracic outlet syndrome treatment with Dr Taj Chowdhry 

Dr Taj Chowdhry, a well-known thoracic expert holds decades of experience in thoracic disorders and complexities. With a commitment to personalized care and innovative approaches, he ensures that each patient receives tailored treatment strategies to alleviate symptoms and improve quality of life. 

Trust in Dr Taj’s in-depth know-how has helped several individuals overcome TOS issues, navigate their paths towards recovery and regain comfort and functionality in their daily lives. 

Quick FAQs 

Is Thoracic Outlet Syndrome a common condition? 

Thoracic Outlet Syndrome is considered a rare condition, affecting a relatively quite a small percentage of the population. Nevertheless, it can occur in individuals of any age or gender, although it is more commonly seen in women and those with certain risk factors such as poor posture or repetitive arm motions. 

Can Thoracic Outlet Syndrome be prevented? 

While it may not be entirely preventable, maintaining good posture, avoiding repetitive overhead arm movements, practicing ergonomic principles at work, and incorporating regular stretching and strengthening exercises for the shoulder and neck muscles may help reduce the risk of developing Thoracic Outlet Syndrome. 

What are the complications of untreated Thoracic Outlet Syndrome? 

Untreated Thoracic Outlet Syndrome can lead to chronic pain, weakness, and disability in the affected arm or hand. In severe cases, it may result in permanent nerve or vascular damage, blood clots, or other serious complications requiring immediate medical attention. 

Can Thoracic Outlet Syndrome affect daily activities or work performance? 

Yes, Thoracic Outlet Syndrome can significantly impact daily activities and work performance, especially those that involve repetitive arm movements or maintaining certain postures for extended periods. Individuals with Thoracic Outlet Syndrome may experience difficulty performing tasks requiring fine motor skills or lifting heavy objects.