Thoracic Outlet Syndrome

Thoracic outlet syndrome, also known as TOS, is a condition where the nerves or blood vessels passing through the side of the neck are compressed between the collarbone and the first rib. This could lead to pain, numbness, tingling, and weakness in the shoulder, arm, hand, and neck. The space between the neck and the shoulder is known as the thoracic outlet.

Causes 

Common causes for this condition to arise are:

• Trauma from a car accident or fall, causing injury to the neck or upper chest.

• Repetitive injuries from a job or sport

• Presence of an extra or irregular rib

• Poor posture over prolonged periods.

• During pregnancy, hormonal changes can loosen joints, leading to TOS

• Tumors in the neck or upper chest can press on the nerves and blood vessels.

Types

There are 3 types of TOS:

1. Neurogenic TOS: This is the most common type, where a group of nerves called the brachial plexus is compressed, which come from the spinal cord and help with muscle movements and sensation

2. Venous TOS: This occurs when one or more veins under the collarbone are compressed and damaged, and can result in blood clots.

3. Arterial TOS: This is the least common type of TOS and occurs when the arteries under the collarbone are compressed and can lead to an aneurysm or clot formation

Based on the type of TOS, the symptoms vary:

• Neurogenic TOS can cause numbness, tingling in the arm or fingers, and pain in the neck, shoulder, arm, or hand. There can also be weakness in arm activities and a weak grip.

• Venous TOS can cause changes in the colour of the hand or fingers, hand or arm pain, and swelling.

• Arterial TOS can cause a pulsating lump near the collarbone, cold fingers, hands or arms, pain, or a weak or no pulse in the affected arm.

Treatment

Treatment for TOS depends on the type and severity of symptoms, which include:

Physiotherapy: 

• This is the first line of treatment, which involves strengthening and stretching the muscles of the neck and shoulder to improve posture and range of motion.

• Pain-relieving modalities are also given.

• Lifestyle changes like avoiding repetitive movements causing the symptoms and good ergonomics are taught to the patient 

Medications and injections:

Pain relievers and muscle relaxants are given along with anticoagulants for blood clots, injections, or steroids can also help with pain.

Surgical intervention:

If the conservative treatment is not helping, the pressure can be relieved with surgical options based on the structure causing the problem, like reconstructing the damaged vessels or removing the extra rib, or decompression surgery of scalene muscle release.