Thoracic Outlet Syndrome (TOS): Causes, Symptoms, and Treatment

Thoracic Outlet Syndrome (TOS): Causes, Symptoms, and Treatment

Thoracic Outlet Syndrome (TOS) is a complex and often underdiagnosed condition that affects the nerves and blood vessels located between the collarbone (clavicle) and the first rib — an area known as the thoracic outlet. This narrow space can become compressed, leading to a range of symptoms that can significantly impact daily life.

What is Thoracic Outlet Syndrome?

The thoracic outlet is a passageway for important nerves and blood vessels traveling from the neck and chest into the arm. When these nerves or blood vessels are compressed or irritated, it results in Thoracic Outlet Syndrome. This compression can cause symptoms depending on what structures are compressed. Typical symptoms include pain around neck, shoulders & arms, tingling & numbness affecting the finers, weakness of the hand. These symptoms are typically made worse by arm movements such as driving, lifting hands above shoulders, exercise, lifting weights.

Types of Thoracic Outlet Syndrome

There are three main types of TOS, classified by what structure is compressed:

1. Neurogenic TOS (most common) — compression of the brachial plexus nerves.

2. Venous TOS — compression of the subclavian vein. This can prsent with symptoms of  intermittent swelling of arm on exercise or can lead to acute upper limb deep vein thrombosis.

3. Arterial TOS — compression of the subclavian artery causing damage to artery and blood flow. This is rare and can lead to sudden damage to blood flow to arm and can be limb threatening

Each type has slightly different symptoms and risks.

Causes and Risk Factors

Symptoms of TOS are typically seen in young adults aged between 18 – 50 yrs of age. Although TOS can present rarely in older age too.

Some risk factors for TOS include:

·        Anatomical variations: Extra ribs (cervical ribs), muscle hypertrophy or abnormal ligaments.

• Trauma or injury: Such as a car accident or repetitive strain injuries.

• Repetitive activities: Jobs or sports involving repetitive overhead arm movements.

 

Symptoms of Thoracic Outlet Syndrome

The symptoms vary depending on the type of TOS:

• Neurogenic TOS: Numbness, tingling, weakness, or pain in the arm and hand; muscle wasting in severe cases.

• Venous TOS: Swelling, pain, and a bluish discoloration of the arm.

• Arterial TOS: Coldness, paleness, and weakness of the arm and hand, sometimes accompanied by pain.

Many people experience symptoms that worsen with activity or certain positions.

Diagnosis

Diagnosing TOS can be challenging because symptoms overlap with other conditions like carpal tunnel syndrome or cervical spine disorders. Diagnosis usually involves:

• A detailed medical history and physical exam.

• Imaging tests like X-rays (to detect extra ribs), MRI, ultrasound.

• Nerve conduction studies and vascular studies to evaluate blood flow and nerve function.

Treatment Options

Treatment depends on the severity and type of TOS:

• Physical therapy: Focuses on posture correction, stretching, and strengthening exercises.

• Medications: Pain killers, anti-inflammatory drugs, or muscle relaxants.

• Lifestyle changes: Avoiding repetitive overhead movements and improving ergonomics.

• Surgery: Considered in severe cases when conservative treatments fail, aiming to relieve pressure by removing the first rib or releasing tight muscles.

Living with Thoracic Outlet Syndrome

Many people with TOS improve with conservative treatments and lifestyle adjustments. Early diagnosis and proper management are key to preventing complications. If you experience persistent arm or neck pain, numbness, or weakness, which are significantly impacting your life style, consult a healthcare provider with expertise in TOS, for an evaluation.

Mr. Devaraj Srinivasamurthy

Vascular & Endovascular Expert Care