From the Guidelines
Thoracic outlet syndrome (TOS) is a condition where blood vessels or nerves in the space between your collarbone and first rib (thoracic outlet) become compressed, causing pain in your shoulders and neck and numbness in your fingers. There are three main types: neurogenic (affecting nerves), venous (affecting veins), and arterial (affecting arteries), with neurogenic being most common, as noted in the study by 1. Symptoms typically include:
- Pain
- Numbness
- Tingling in the neck, shoulder, arm or hand
- Weakened grip
- Discoloration of the hand Treatment usually begins conservatively with physical therapy to strengthen chest muscles and improve posture, along with pain relievers like NSAIDs, as recommended by 1. For severe cases that don't respond to conservative treatment, surgery may be necessary to remove the first rib or repair blood vessels, as suggested by 1. TOS often develops from repetitive activities, poor posture, anatomical abnormalities like an extra rib, or trauma, as explained in the study by 1. Early diagnosis and treatment are important to prevent permanent nerve damage or vascular complications, emphasizing the need for prompt medical attention, as highlighted by 1. The use of imaging techniques such as CT or MRI can help diagnose TOS, as discussed in the studies by 1, 1, and 1, which provide guidance on the appropriate use of these imaging modalities. Overall, a comprehensive approach to diagnosis and treatment, taking into account the individual patient's symptoms and medical history, is essential for effective management of TOS, as supported by the evidence from 1, 1, 1, 1, and 1.
From the Research
Definition and Classification of Thoracic Outlet Syndrome
- Thoracic outlet syndrome (TOS) is a group of disorders that result from the dynamic compression of blood vessels or nerves between the clavicle and first rib or cervical vertebral nerve roots 2.
- TOS can be classified into three types: neurogenic, venous, and arterial, according to the primarily affected structure 3, 4.
- Neurogenic TOS is further divided into true neurogenic and disputed TOS, with the latter being a topic of controversy among clinicians 4.
Symptoms and Causes of Thoracic Outlet Syndrome
- Individuals with TOS typically experience upper limb pain, numbness, tingling, or weakness that is exacerbated by shoulder or neck movement 2.
- The causes of TOS vary and can include abrupt movements, hypertrophy of the neck musculature, anatomical variations, edema, pregnancy, repeated overhead motions, and abnormal posture 2.
- Other causes of TOS include congenital abnormalities, such as cervical ribs or fibrous bands, and neck trauma or repeated work stress that can cause scalene muscle scarring or dislodging of a congenital cervical rib 3.
Diagnosis and Treatment of Thoracic Outlet Syndrome
- Diagnosis of TOS is often made through a combination of history, physical examination, and imaging studies 3, 5.
- Treatment options for TOS include conservative management, such as physical therapy, lifestyle modifications, and medication, as well as surgical decompression for patients who have failed conservative therapy 3, 5.
- Surgical treatment options include brachial plexus decompression, neurolysis, and scalenotomy with or without first rib resection, but may be associated with complications such as injury to the subclavian vessels or brachial plexus 3.