Thoracic Outlet Syndrome
What is Thoracic Outlet Syndrome (TOS)?
TOS describes a group of disorders that occur when nerves or blood vessels in the upper chest or shoulder area become compressed. Symptoms arise when the brachial plexus and the subclavian artery and vein, which have to pass several narrow passageways, are compressed at the thoracic outlet. Compression occurs either intermittently or permanently and can result from a congenital anomaly such as an abnormal first rib, increased muscle growth or traumatic injury. TOS is also a collective title for a variety of syndromes as Scalenus Anterior Syndrome, Cervical Rib Syndrome, Costaclavicular Syndrome, Pectoralis Minor Syndrome, and Thoracic Inlet Syndrome.
What are the symptoms of TOS?
The most frequent symptoms of TOS are pain in the backside of the shoulder or the armpit radiating to fourth and fifth finger, numbness or tingling in the fingers or the whole arm. Symptoms can also include weakness of the arm in advanced stages or discoloration of the hand if the artery is compressed. Symptoms are often worse at night or when elevating the arm.
How is TOS diagnosed?
The diagnosis of TOS is usually made on the basis of several clinical tests. Additionally, imaging tests as x-rays, ultrasound of the vascular structures or nerve conduction tests are necessary. In some cases, CT-scans or MRI of the shoulder may be ordered.
How is TOS treated?
TOS can be treated conservatively or surgically. In most of the cases, treatment can be successful with conservative measures as e.g. special physical therapy, ergo therapy and physical measures (heat application). But treatment may also include pain medication. If physical therapy does not improve the symptoms or in case of advanced TOS surgery may be necessary. The goal of surgery is to identify and correct the narrowing that is causing problems.
Our specialists will be glad to advise you which treatment would be the proper option for you.
A 42-year-old woman presented complaining of pain in the left side of the neck. The symptoms got worse when turning the head to the left. Furthermore, she complained of numbness in the fingers as well as of loss of strength in the left arm under stress.
CT-scan showed a cervical rib on the left side (red arrow on the figure) so that TOS diagnosis could be confirmed.
The first rib was removed surgically. Post-operative CT-scan showed a complete resection of the rib. The patient is fully recovered.