What is Thoracic Outlet Syndrome?
Thoracic Outlet Syndrome (or TOS) occurs when the blood vessels and nerves in between your collarbone and upper ribs (or thoracic outlet) become compressed, causing pain, numbness, or tingling along the neck, shoulders, arms, and fingers.
There are two types of TOS:
- Neurogenic thoracic outlet syndrome involves compressed or pinched nerves, and it is the most common form of TOS.
- Vascular thoracic outlet syndrome occurs when the blood vessels or arteries are pinched.
TOS can result from any type of physical trauma from whiplash in a car to repetitive or overuse injuries in sports, like baseball.
If not treated properly, TOS can result in permanent nerve damage or a blocked artery which can be very serious.
Thoracic Outlet Syndrome Symptoms
TOS can sometimes be difficult to diagnose because its symptoms share characteristics of many other conditions such as rotator cuff or cervical disc injuries, fibromyalgia, or multiple sclerosis.
Common symptoms of Thoracic Outlet Syndrome include:
- Numbness, pain, heaviness, or tingling in the shoulder, arms, hands, or fingers
- Sudden aches or pains in neck or shoulders
- Weakened grip
- Discoloration of hand or fingers (typically blue or purple)
- Weakened pulse
- Throbbing lump or sensation in the upper chest near the collarbone
Diagnostic tests that may help confirm TOS are blood tests, X-rays to view bone health, an EMG (electromyography) to measure muscle strength, or an MRI to check for arterial blockages.
What are the risk factors for Thoracic Outlet Syndrome?
Thoracic Outlet Syndrome is most commonly diagnosed in women who are between 20 and 50 years of age. Risk factors that might contribute to TOS are:
- Traumatic injuries
- Anatomical defects in the neck or chest
- Tumors in the neck or chest
- Poor posture over a long period
- Pregnancy as excess pressure is put on the entire body
- Repetitive arm and shoulder movements or activity, such as from playing certain sports like tennis or golf
Thoracic Outlet Syndrome Treatments
If you experience symptoms of TOS for several days, seek medical attention. To relieve symptoms of most cases of TOS, treatment might include:
- Physical therapy with targeted exercises to strengthen chest muscles and improve posture
- Non-steroidal anti-inflammatory medications
- Thrombolytics to break up and prevent blood clots
- Muscle relaxers
Thoracic Outlet Syndrome Exercises
Your healthcare provider may suggest Thoracic Outlet Syndrome exercises to aid in your recovery. It’s important to speak with your healthcare provider or physical therapist to determine which exercises are optimal for you and how to perform them safely and effectively.
- Pectoralis Stretch: To do a pectoralis stretch, position yourself in an open doorway or corner with your hands slightly above your head on the door frame or wall. Gradually lean forward until you sense a stretch in the front of your shoulders. Maintain this position for 15 to 30 seconds and then repeat the process three times.
- Scapular Squeeze: To perform the scapular squeeze exercise, start by sitting or standing with your arms at your sides. Then, squeeze your shoulder blades together and hold for 5 seconds. Repeat this movement for 2 sets of 15.
- Scalene Stretch: You can either sit or stand and clasp both hands behind your back. Begin by lowering your left shoulder and tilting your head towards the right until you feel a stretch in your neck. Hold this position for 15 to 30 seconds before returning to your starting position. Then, lower your right shoulder and tilt your head towards the left side. Hold for another 15 to 30 seconds before repeating the stretch on both sides for a total of 3 times.
- Thoracic Extension: Sit on a chair and interlock both arms behind your head. Slowly lean backward while looking towards the ceiling. Repeat this exercise 10 times and practice it a few times daily.
- Arm Slide: Start by standing or sitting with your back pressed against a wall. Place your elbows and wrists against the wall and gradually slide your arms upward as far as you can without moving your elbows or wrists away from the wall. Repeat this movement for 2 sets of 8 to 12 repetitions.
- Mid-Trap: Lie face down on a solid surface and slide a folded pillow under your chest. Extend your arms out to the sides with your elbows straight and thumbs pointing up. Gradually lift your arms towards the ceiling while squeezing your shoulder blades together. Lower them slowly. Repeat for 3 sets of 15 reps. As you progress and the exercise becomes easier, consider holding soup cans or small weights in your hands.
- Rowing: Secure the middle of an elastic band in a door or wrap it around an immovable object. Grip one end of the band in each hand while sitting in a chair. Bend your arms to a 90-degree angle, ensuring your forearms are vertical and your elbows are at shoulder level, also bent at a 90-degree angle. Squeeze your shoulder blades together as you pull back on the band. Repeat for 2 sets of 15 repetitions.
In severe cases, thoracic outlet decompression surgery may be necessary to relieve pressure on the affected area of the chest.
Our board-certified thoracic and vascular surgeons at CTVS who specialize in treating TOS are: