Thoracic Outlet Syndrome (TOS), like other syndromes, is a group of symptoms that develop when one or more blood vessels, ateries and/or nerves in the thoracic outlet (a narrow passageway between your clavicle and first rib) are compressed. This can happen when the thoracic outlet pathway becomes too squeezed off, or when nerves/blood vessels/arteries feeding through it are injured or irritated. Common causes can include traumatic events, such as a car accident or sports injury, wear and tear from repetitive movements, poor posture, obesity, pregnancy or structural abnormalities.
Neurogenic (neurological) TOS can cause such symptoms as symptoms such as:
- Hand discoloration
- Hand weakness
- Pain and/or numbness in the fingers, hand, arm, shoulder or neck
Vascular TOS can cause:
- Swollen and/or red arm
- Cold hands or arms
- Hands or arms becoming easily fatigued
- Difficulty lifting objects overhead
- Limited range of motion (ROM) in the arms and shoulders
There is also a non-specific form of TOS, where the patient has pain in the thoracic outlet area that gets worse with activity but there is no way to determine the cause.
To diagnose or rule out Thoracic Outlet Syndrome, your physician will run what are known as "provocation tests" in an effort to replicate your symptoms. Provocation tests may include your doctor asking you to move your neck and upper extremities in different positions to see if you develop symptoms.
If you show symptoms during the provocation tests, your doctor may order additional tests to confirm the diagnosis and determine what's causing your symptoms. These tests may include:
- An X-ray - this can help determine if there is an extra rib causing symptoms and possibly rule out other conditions.
- Magnetic Resonance Imaging (MRI) - this can help determine where the compression is taking place and what's causing it. It may also reveal structural abnormalities.
- Electromyography (EMG) - this is a test of how well the muscles respond when the motor neurons that control them are stimulated. EMG is used to diagnose muscular abnormalities.
- Nerve Conduction Study (NCS) / Nerve Conduction Velocity (NCV) Test - NCS measures how fast an electrical impulse travels through a nerve. NCS is used to diagnose nerve damage.
Thoracic Outlet Syndrome is typically treated with a combination of physical therapy and medication. Surgery is not commonly needed.
If you are experiencing pain or numbness in your arm, hand, fingers, shoulder or neck, give us a call at