Thoracic Outlet Syndrome (TOS)

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome (TOS) is a condition that happens when the nerves or blood vessels between the collarbone and first rib become compressed.

The disorder occurs when a change or enlargement is present in the tissues near the first rib. This can appear as a result of various factors such as trauma, anatomical defects, poor posture, pressure on the joints, pregnancy, and repetitious movements. Young adult females are among those more likely to experience the condition.

There are three kinds of thoracic outlet syndrome:

  • Neurogenic (compression is due to an extra cervical rib present since birth)
  • Vascular (compression of the vein and artery)
  • Non-specific type (symptoms of TOS are present without a clear cause)

What are the Symptoms of Thoracic Outlet Syndrome?

Depending on the type, patients experiencing thoracic outlet syndrome may notice a variety of symptoms.

Symptoms include:

  • Shoulder, arm, and neck pain
  • Numbness in hand, arm, or fingers
  • Impaired blood circulation in the extremities
  • Weakness in the arm, shoulders, and hands
  • Cold arms, hands, and fingers
  • Headache
  • Swelling in the arm
  • Weakened grip
  • Discoloration in the hands
  • Pallor in the fingers
  • Weak or lack of pulse in affected arm
  • Throbbing lump near the collarbone

Some patients may also be susceptible to the formation of blood clots with the condition. Left untreated, it can ultimately result in nerve damage.

Causes of Thoracic Outlet Syndrome

Thoracic Outlet Syndrome is caused when the blood vessels or the nerves underneath the clavicle (or collarbone) are compressed.

There are many ways compression can happen, including:

  • Poor posture: holding the head in a position that is slanted forward or drooping shoulders can create compression for the thoracic outlet.
  • Trauma: events that are especially traumatic can instigate changes internally that compress nerves in the region of the thoracic outlet.
  • Anatomical defects: birth defects can comprise of a tight fibrous band that joins the ribs to the spine, or an extra rib that sits near the first rib.
  • Repetitious activity: the tissue of the body can be worn if the same activity is repeated over and over. Typing, lifting objects above the head (such as stocking shelves), or working on an assembly line are some repetitious activities that can cause TOS. Athletes are also affected, such as swimmers or baseball pitchers, because they typically repeat the same movements for years.
  • Pregnancy: joints are loosened when women become pregnant and signs of TOS can appear first under these circumstances.
  • Pressure on the joints: obesity and carrying heavy objects can put added stress on the joints.

How is Thoracic Outlet Syndrome Treated?

Most of the time, conservative treatments are sufficient in treating thoracic outlet syndrome, particularly when it is diagnosed early.

Physical therapy through strengthening and stretch exercises is often tried first. If needed, a doctor can prescribe anti-inflammatory medications to treat pain and swelling and promote the relaxation of muscles.

Clot-dissolving drugs will be given to patients with blood clots.

Surgery is only recommended if other therapies have been ineffective, as it involves higher risks of complications and is not always a successful option.

Prevention of Thoracic Outlet Syndrome

Companies are responsible for ensuring the work areas are ergonomically friendly, and athletes are responsibly for keeping their bodies in fit and healthy condition. Ergonomics can improve comfort for employees and can also maximize efficiency.

Warming up properly and sitting with correct posture can reduce daily fatigue. Proper mechanics such as stretching can be of immense help in avoiding unnecessary injury.

Drinking water is important because the human body has at least 70% water in healthy muscles. If the muscles become dehydrated, they have a much higher likelihood of experiencing strain, muscle fatigue, tendonitis, and many other movement system disorders. It is also important to eat healthy food because the nutrients in food determine how well the body can fight illness or disorders from the inside.

Getting enough sleep is also important because stress hormones are increased if the body is short on rest. Less sleep also directly correlates to chronic diseases and injuries. Proper exercise also contributes to muscular health; the types that the human body needs include strength, aerobic/cardiovascular, relaxation, and stretching exercises. Vitamins can assist in fighting inflammation and fatigue, but should not be substituted for a healthy diet.

Last Reviewed:
October 11, 2016
Last Updated:
September 11, 2017
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