What Is Thoracic Outlet Syndrome?
Thoracic outlet syndrome refers to a
group of conditions that develop when the blood vessels or nerves in the
thoracic outlet become compressed. The thoracic outlet is the narrow space
between your collarbone and first rib. Blood vessels, nerves, and muscles that
extend from the back to the arms pass through this area. If the space in the
thoracic outlet is too narrow, these structures can become compressed. The
increased pressure on the blood vessels and nerves may cause pain in your
shoulders, neck, and arms. It can also cause numbness or tingling in your
The cause of thoracic outlet syndrome
isn’t always known. However, it may be triggered by physical trauma from a car
accident, repetitive movements, or certain structural abnormalities.
Treatment for thoracic outlet syndrome
typically consists of physical therapy and medication. Surgery may be needed if
symptoms don’t improve after initial treatment.
What Are the Symptoms of Thoracic Outlet
The symptoms that you experience as a
result of thoracic outlet syndrome will depend on whether the nerves or the
blood vessels are affected.
Compressed nerves can cause:
- pain in parts of the neck, shoulder, arm, or
- numbness in the forearm and fingers
- weakness of the hand
Compressed blood vessels can cause:
- swelling of the arm
- redness of the arm
- hands or arms that feel cold to the touch
- hands or arms that become easily fatigued
You may also find it difficult to lift
objects above your head. You might also have a limited range of motion in your
shoulders and arms.
What Causes Thoracic Outlet Syndrome?
Thoracic outlet syndrome usually
occurs when the thoracic outlet becomes narrowed and compresses the nerves and
blood vessels. The cause of this compression isn’t always known. However, it
may develop as a result of the following conditions:
An Extra Rib
Some people are born with an extra rib
above their first rib. This reduces the size of their thoracic outlet and
compresses nerves and blood vessels.
Poor Posture and Obesity
People who don’t stand up straight or
who have excess abdominal fat may have increased pressure on their joints. This
can cause a narrowing of the thoracic outlet.
Car accidents and other traumatic
injuries can compress the thoracic outlet as well as the vessels and nerves in
Overuse of the Shoulders and Arms
Repetitive activities, such as working
at a computer or lifting heavy objects above the head, can cause damage to the
tissues in the thoracic outlet. Over time, the size of the thoracic outlet may
shrink, placing pressure on the vessels and nerves.
How Is Thoracic Outlet Syndrome Diagnosed?
Your doctor will first perform a physical
exam and review your symptoms and medical history. During the exam, your doctor
may use what are called “provocation tests” to evaluate your condition. These
tests are meant to reproduce your symptoms so your doctor can make a diagnosis
more easily. Your doctor will ask you to move your neck, shoulders, and arms in
different positions. For example, they may ask you to put your hands over your
head or to open and close your hands for three minutes. If your symptoms
develop during provocation tests, then you likely have thoracic outlet
To confirm the diagnosis, your doctor
may order additional tests, including the following:
- An X-ray of the thoracic outlet can reveal
whether you have an extra rib. It may also rule out other conditions that could
be causing your symptoms.
- An MRI uses powerful magnets and radio waves to
create clear, detailed images of the thoracic outlet. The pictures can help
determine the location and cause of the compression. They may also show certain
structural abnormalities that could be causing your symptoms.
- Electromyography allows your doctor to see how well
the muscles and nerves in the thoracic outlet are working. During this test, an
electrode is inserted through your skin into various muscles. It evaluates the
electrical activity of your muscles when at rest and when contracted.
- A nerve conduction study uses a low amount of
electrical current to measure how quickly your nerves send impulses to various
muscles throughout the body. It can determine whether you have nerve damage.
How Is Thoracic Outlet Syndrome Treated?
The goal of treatment for thoracic
outlet syndrome is to ease symptoms and pain. The specific type of treatment
used may vary depending on the cause and severity of the condition. You and
your doctor can discuss which treatment option is best for you.
Treatment for thoracic outlet syndrome
typically starts with the use of medications to help ease your symptoms. Over-the-counter
medications, such as naproxen
may be used to reduce inflammation and pain. In some cases, your doctor may
give you thrombolytic drugs through your veins or arteries to dissolve blood
clots in the thoracic outlet. They might also prescribe anticoagulants
to prevent blood clots from forming and blocking blood flow.
Physical therapy is also recommended
to help strengthen and stretch the shoulder muscles. Strengthening these
muscles will improve your range of motion as well as your posture. It will also
provide support for the collarbone and muscles surrounding the thoracic outlet.
Over time, physical therapy exercises may take the pressure off the blood
vessels and nerves in the affected area.
If you’re overweight, your doctor may recommend
a weight-loss program or specific diet to help relieve symptoms. Maintaining a
healthy weight is important for reducing pressure on the joints.
You may need surgery if your symptoms
don’t improve with medication and physical therapy. Surgery for thoracic outlet
syndrome might involve removing an extra rib, removing a section of the first
rib, or rerouting blood vessels around the thoracic outlet. If the vessels in
the thoracic outlet are severely narrowed, angioplasty may be used to open them
up. During angioplasty, tiny balloons are used to inflate the narrowed vessels.
What Is the Outlook for People with Thoracic
The outlook for people with thoracic
outlet syndrome is typically very good, especially when treatment is received
promptly. In most cases, the symptoms of thoracic outlet syndrome will improve
with medication and physical therapy. Surgery also tends to be effective in
treating the condition. However, the symptoms may return after surgery for some
How Can Thoracic Outlet Syndrome Be
It may not be possible to prevent
thoracic outlet syndrome. However, if the condition develops, you can take
steps to reduce symptoms and to prevent it from recurring. These include:
- practicing proper posture when sitting or
- taking breaks at work or school to stretch and
- maintaining a healthy weight
- performing strengthening exercises
- avoiding activities that make your symptoms worse
- avoiding lifting heavy objects
- avoiding carrying heavy bags on the shoulders
- avoiding making repetitive movements
It’s important to contact your doctor
as soon as you notice a recurrence of symptoms. Getting prompt treatment is
critical for preventing complications. When the condition goes untreated,
thoracic outlet syndrome can eventually lead to permanent neurological damage.