Thoracic Outlet Syndrome occurs when the blood vessels or nerves in the space between your collarbone and your first rib (the thoracic outlet) become compressed. This can cause significant pain and numbness in the shoulder, neck, and fingers.
Symptoms vary depending on whether nerves or blood vessels are being squeezed:
Neurological (Most Common): Numbness or tingling in the arm and fingers (often the ring and pinky fingers), hand weakness, and a dull ache in the neck or shoulder.
Vascular: A bluish tint to the hand, a weak or absent pulse in the affected arm, coldness in the fingers, or swelling in the arm due to blood clots.
Positional Pain: Symptoms often flare up when holding the arms overhead or reaching forward (like typing or driving).
TOS can be challenging to diagnose because it mimics other conditions like carpal tunnel or cervical disc issues.
Physical Exam
Electromyography (EMG): This test measures the electrical activity of muscles to confirm nerve compression.
Imaging: X-rays can check for an extra rib, while Ultrasound or CT Angiography can visualize blood flow and identify where vessels are being pinched.
Most patients find relief through non-invasive methods designed to open up the thoracic outlet space.
Physical Therapy: This is the primary treatment. It focuses on improving posture, strengthening the muscles that lift the collarbone, and stretching the chest (pectoral) muscles.
Nerve Gliding: Specific exercises help the nerves move more freely through the crowded space.
Anti-Inflammatories: Medications to reduce swelling around the nerve roots or vessels.
Lifestyle Adjustments: Ergonomic changes at your workstation and avoiding heavy bags that pull down on the shoulders.
Surgery: If conservative treatment fails or if there is a high risk of blood clots, surgery may be required to remove a portion of the first rib or a deforming muscle to create more space.