Summary about Disease
Neurogenic Thoracic Outlet Syndrome (NTOS) is a condition where the nerves in the thoracic outlet (the space between your collarbone and your first rib) are compressed, irritated, or injured. This compression most commonly affects the brachial plexus, a network of nerves that controls movement and sensation in your shoulder, arm, and hand. NTOS is often associated with pain, weakness, numbness, and tingling in the affected areas. Unlike vascular TOS (which involves blood vessel compression), NTOS primarily impacts the nerves.
Symptoms
Symptoms of NTOS can vary but commonly include:
Neck pain
Shoulder pain
Arm pain
Hand pain
Numbness or tingling in the fingers (often the pinky and ring fingers)
Weakness in the hand and arm
Fatigue in the arm with activity
Headaches
Impaired fine motor skills
Coldness in the affected extremity
Causes
The causes of NTOS can be multifactorial but typically involve factors that narrow or compress the thoracic outlet space. These may include:
Anatomical abnormalities: Extra ribs (cervical ribs), abnormal muscle attachments, or variations in bone structure.
Trauma: Whiplash injuries, fractures of the clavicle or ribs.
Repetitive activities: Overhead work, weightlifting, typing, or other activities that strain the shoulder and neck muscles.
Poor posture: Slouching or rounded shoulders.
Weight gain or obesity: Which can compress the space.
Tumors or cysts: Rarely, masses can compress the nerves.
Medicine Used
Medications are often used to manage the symptoms of NTOS, but they do not address the underlying cause. Common medications include:
Pain relievers: Over-the-counter pain relievers like ibuprofen (Advil, Motrin) or naproxen (Aleve), or prescription pain medications.
Muscle relaxants: To ease muscle spasms in the neck and shoulder.
Nerve pain medications: Such as gabapentin (Neurontin) or pregabalin (Lyrica) to reduce nerve pain.
Anti-inflammatory medications: Corticosteroids (oral or injected) may be used to reduce inflammation around the nerves.
Antidepressants: Certain antidepressants (e.g., amitriptyline) can also help manage chronic pain.
Is Communicable
NTOS is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Precautions to manage and potentially prevent NTOS include:
Maintain good posture: Sit and stand with your shoulders relaxed and back straight.
Avoid repetitive movements: Take breaks during activities that involve repetitive arm or shoulder motions.
Ergonomic adjustments: Ensure your workstation is properly set up to minimize strain on your neck and shoulders.
Weight management: Maintain a healthy weight to reduce pressure on the thoracic outlet.
Regular exercise: Strengthen the muscles around your shoulders and neck to improve stability.
Avoid carrying heavy bags: Using backpacks or distributing weight evenly can help.
Sleeping Position: Avoiding sleeping on your side with your arm overhead.
How long does an outbreak last?
NTOS is not an "outbreak"-type illness. It's a chronic condition. Symptoms can be intermittent or constant, and the duration of symptom flares can vary widely, from days to weeks or even months. The overall duration depends on the underlying cause, severity, and effectiveness of treatment.
How is it diagnosed?
Diagnosis of NTOS can be challenging. It often involves:
Medical history and physical exam: The doctor will ask about your symptoms and perform a physical exam to assess your range of motion, reflexes, and nerve function.
Provocative tests: Specific maneuvers (e.g., Adson's test, Roos test) are performed to try to reproduce your symptoms.
Nerve conduction studies (NCS) and electromyography (EMG): These tests measure the electrical activity of your nerves and muscles, but can be normal even with NTOS.
Imaging studies: X-rays, MRI, or CT scans may be used to rule out other conditions or identify anatomical abnormalities. MRI is the best imaging to visualize the nerves.
Arteriogram/Venogram: To rule out vascular compression.
Differential Diagnosis: Ruling out other conditions such as cervical radiculopathy, rotator cuff injuries, carpal tunnel syndrome and fibromyalgia.
Timeline of Symptoms
The timeline of NTOS symptoms can vary significantly from person to person.
Gradual onset: Symptoms may develop gradually over weeks, months, or even years, often related to repetitive activities or poor posture.
Sudden onset: Symptoms may appear suddenly after a traumatic injury.
Intermittent symptoms: Pain, numbness, and tingling may come and go, triggered by certain activities or positions.
Progressive worsening: If left untreated, symptoms may gradually worsen and become more constant.
Variable course: Some people experience periods of remission followed by symptom flares.
Important Considerations
Early diagnosis is key: Prompt diagnosis and treatment can improve outcomes and prevent long-term nerve damage.
Multidisciplinary approach: Treatment often involves a combination of physical therapy, medication, and lifestyle modifications.
Surgery is a last resort: Surgical decompression of the thoracic outlet is considered if conservative treatments fail to provide relief.
Underlying conditions: Addressing any underlying anatomical abnormalities or contributing factors is crucial for long-term management.
Individualized treatment: Treatment plans should be tailored to the specific needs and symptoms of each individual.
Psychological impact: Chronic pain from NTOS can have a significant impact on mental health. Addressing psychological aspects of the condition is important.