What is Thoracic Outlet Syndrome (TOS)
Thoracic outlet syndrome is a group of disorders that happens when there is compression or damage of the nerves or/and the vessels in the lower neck area. Thoracic outlet is the anatomic area defined from the first rib and the top border of the clavicle. We have three types of TOS (neurogenic, arterial, venous) depending on the structure that is been compressed.
Who is affected from TOS?
- Young active athletes (swimming, baseball, volleyball players) who participate in activities involving repetitive motions above the shoulder level
- females affected more frequently than males
What are the symptoms?
- Pain in hand and shoulder/neck area
- Easy fatigue with repetitive motions
- Arm swelling and discoloration
- Headaches
- Hand numbness and weakness of neck, chest and arms
- Cold sensitivity in hands and fingers; poor circulation in hands and fingers
- Sleep deprivation
- Decreased Quality of Life (QoL)
How TOS being diagnosed?
Making correct diagnosis is crucial and sometimes very difficult. Doctors who treat the conditions need to be familiar with that disease. Many times, a multidisciplinary approach among vascular surgeons, orthopedics and pain specialists is required.
Tests to assist in diagnosis are:
- Chest X-Ray, Cervical spine X-Ray
- Vascular Ultrasound
- Computed Tomography (CT)
- Magnetic Tomography (MRI)
- Nerve Conduction Studies
How TOS being treated?
For neurogenic TOS in majority of the times a conservative approach with physical therapy and involvement of pain specialists is initially performed. Failure of conservative management may require a surgical intervention. For arterial or venous TOS most of the times a surgical treatment is preferred to reduce the risk of blood clots creation and the risk of venous thromboembolism and pulmonary embolism or major arterial complications.