What is Thoracic Outlet Syndrome (TOS)?
Thoracic Outlet Syndrome (TOS) is a condition that involves compression at the superior thoracic outlet that happens due to pressure placed on excess pressure placed on the neurovascular bundle that passes between the anterior and middle scalene muscles.
There are three types of thoracic outlet syndrome depending on what structure is compressed-nerve, vein, or artery. A majority of the cases of TOS are due to compression of the nerves (neurogenic TOS). Followed by Venous TOS, which occurs due to obstruction or clotting of the main vein. The rarest type of them all is arterial TOS that occurs due to disease in the artery.
What are the Causes of Thoracic Outlet Syndrome (TOS)?
Thoracic Outlet Syndrome (TOS) is mainly caused by enlargement or change of tissues in or near the thoracic outlet.
The following may increase the risk of having TOS.
- Poor posture
- Sleeping disorders
- Existence of tumors or lymph nodes in the upper chest
- Repetitive injuries caused by carrying heavy loads on the shoulders
- Neck or back injury
What are the Symptoms of Thoracic Outlet Syndrome (TOS)?
Symptoms of Thoracic Outlet Syndrome (TOS) may vary depending on the type of nerve or blood vessels compressed. Symptoms associated with nerve compression are more common than symptoms from blood vessel compression. They include:
- Pressure on the nerves: This may cause aching pain in the neck, shoulder, arms or hands. It can further cause numbness and tingling on the inside of the forearm accompanied by weakness of your hand.
- Pressure on blood vessels: It reduces blood flow out of your arm leading to swelling and redness of the arm.
- Overhead activities become difficult as they worse with the nature of compression.
- Depression in the shoulders, and swelling or discoloration around your arm
Limited range of motion
How is Thoracic Outlet Syndrome (TOS) Diagnosed?
Diagnosis of TOS can be more complicated as compared to other conditions since there may be many more symptoms to explain. The doctor’s evaluation will comprise of an extensive medical history, physical examination, as well as diagnostic testing.
First the doctor at pain management clinics in Nashville TN will ask you about the history of the symptoms you may have experienced after which they may perform a physical examination to try and reproduce your symptoms by examining your arm and hand.
The doctor at the Nashville pain clinic will also carry out an elevated arm stress test to help them identify thoracic outlet syndrome. The doctor will need you to raise your arms over the head, and then open and close your fists for about 3 minutes. If this exercise reproduces your symptoms, then you have TOS. Also, to get a clear view of the bones, tendons, muscle and blood vessels, your doctor may order imaging tests such as x-rays, CT scans, a ultrasound or magnetic resonance imaging (MRI) scans.
Treatment of Outlet Syndrome (TOS)
The most common treatment options for patients with TOS include:
- Physical therapy: Exercises are important since they help strengthen muscles surrounding the shoulders to enable them support the collarbone. This includes postural exercises that help you stand and sit straight.
- Medications such as Nonsteroidal Anti-inflammatory Drugs. Drugs such as ibuprofen and naproxen can ease the pain and reduce swelling.
- Weight loss: For those who are overweight, the doctor a weight loss program since being overweight can stress shoulder muscles.
- Changes in Lifestyle: You will need to avoid strenuous activities, change your workstation layout and modify everyday activities that may accelerate TOS symptoms.
In severe cases where nonsurgical treatment does not work, your doctor may recommend surgery. This entails removing a portion of the first abnormal rib to release the muscle that joins the neck and the chest.