Thoracic outlet syndrome (TOS) is a condition that occurs when nerves or blood vessels in the thoracic outlet, a narrow space between the collarbone and first rib, become compressed or irritated. This can cause pain and other symptoms in the neck, shoulder, arm, and hand. TOS is classified into three types based on the location of compression: neurogenic TOS, vascular TOS, and nonspecific-type TOS.
Symptoms
The symptoms of TOS can vary depending on the type of TOS and the location of compression, but can include:
- Pain in the neck, shoulder, arm, or hand
- Numbness or tingling in the arm or hand
- Weakness in the arm or hand
- Swelling or discoloration of the arm or hand
- Aching pain in the shoulder or upper back
- Coldness in the fingers or hands
- Fatigue in the arms or hands with use
- Throbbing lump near the collarbone
Causes and risk factors
TOS can be caused by a variety of factors including trauma or injury, repetitive overhead movements, poor posture, anatomical abnormalities, or muscle imbalances. Individuals who participate in sports that require repetitive overhead movements, such as baseball, swimming, or tennis, are at an increased risk of developing TOS. Women are also more likely to develop TOS than men.
Associated conditions
There are several conditions that may be associated with TOS, including:
- Cervical spine conditions, such as cervical disc herniation or degenerative disc disease
- Thoracic spine conditions, such as kyphosis or scoliosis
- Shoulder conditions, such as rotator cuff tear or bursitis
- Neurological conditions, such as multiple sclerosis or Parkinson’s disease
Diagnosis and differential diagnosis
Diagnosis of TOS typically involves a physical examination and medical history, including evaluation of the patient’s posture and range of motion. Imaging studies such as X-rays, CT scans, or MRI may be ordered to rule out other conditions that can cause similar symptoms. Differential diagnosis includes carpal tunnel syndrome, cubital tunnel syndrome, cervical radiculopathy, and brachial plexus injury.
Treatment options
Treatment options for TOS depend on the type and severity of the condition. Conservative treatments include physical therapy, stretching exercises, postural correction, and ergonomic adjustments. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants may be used to manage pain and inflammation. If conservative treatment is not effective, more invasive treatments such as corticosteroid injections or surgery may be considered.
Typical recovery timeframes and prognosis
The recovery time for TOS varies depending on the severity of the condition and the type of treatment used. In mild cases, conservative treatment may be effective in relieving symptoms within a few weeks. In more severe cases, surgical intervention may be necessary, and recovery can take several months. The prognosis for TOS is generally good with proper treatment, although some patients may experience chronic pain or disability.