Thoracic outlet syndrome

Thoracic Outlet Syndrome

Definition

TOS is an umbrella term that encompasses three related syndromes that involve compression of the nerves, arteries, and veins in the lower neck and upper chest area and cause pain in the arm, shoulder, and neck.

Alternate names

TOS

Epidemiology

• The exact incidence of TOS is challenging to determine due to varied symptoms and lack of a specific diagnostic test.
• Estimates range from 3 to 80 cases per 1000 people.
• TOS is more prevalent in women.

Causes

• TOS may result from physical trauma, anatomical defects, tumors, poor posture, pregnancy, or repetitive arm and shoulder movements, such as from sports.
• It involves compression of the brachial plexus or subclavian vessels, leading to disagreement in diagnosis and treatment approaches.

Onset

• Symptoms typically occur between 20 and 50 years of age.

Types and Symptoms

• Arterial TOS (A-TOS): Compression of the subclavian artery, usually by a cervical rib.
• Symptoms: Blood clots, arm pain with exertion, or acute arterial thrombosis.
• Venous TOS (V-TOS): Compression of the subclavian vein, often linked to repetitive arm activities.
• Symptoms: Pain, swelling, and deep vein thrombosis.
• Traumatic neurovascular TOS: Following trauma to the collarbone, affecting both nerves and vessels.
• Symptoms: Pain, swelling, bruising, weakness, and sensory loss in the arm and hand.
• True neurogenic TOS (TN-TOS): Caused by compression of the brachial plexus.
• Symptoms: Numbness, abnormal sensations, weakness in arms and shoulders, pain in neck, shoulder, or hand.
• Disputed TOS: Majority of neurogenic cases; controversial as it lacks consistent physical abnormality or standard treatment.
• Symptoms: Pain, tingling, numbness in the neck, arm, and hand.

Clinical Presentation

• Symptoms vary among individuals. Common symptoms include paresthesia (pins and needles feeling), rib abnormalities, arthralgia (joint pain), edema (fluid retention), muscle weakness, myalgia (muscle ache), EMG abnormalities, muscle spasm, varicose veins, and venous thrombosis.

Diagnosis

• Diagnosis is challenging due to symptom overlap with other conditions like rotator cuff injuries, cervical disc disorders, fibromyalgia, multiple sclerosis, and others.
• Tests include chest X-ray, ultrasound, CT scan, MRI, arteriography, venography, and brachial plexus block.

Treatment

• Initial treatment includes exercise programs, physical therapy, and NSAIDs like naproxen or ibuprofen.
• Severe cases might require thoracic outlet decompression surgery.

NIH genetic and rare disease info

• NIH info on Thoracic outlet syndrome

Thoracic outlet syndrome is a rare disease.

Thoracic outlet syndrome Resources
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