Summary about Disease
Thoracic Outlet Syndrome (TOS) is a group of conditions that occur when nerves or blood vessels in the space between your collarbone and your first rib (thoracic outlet) are compressed. This compression can cause pain in your shoulder and neck, numbness in your fingers, and impaired circulation to the arm and hand. There are three main types of TOS: Neurogenic TOS (affecting nerves), Venous TOS (affecting veins), and Arterial TOS (affecting arteries).
Symptoms
Symptoms vary depending on the type of TOS, but common symptoms include:
Neurogenic TOS:
Pain, aching, or tingling in the neck, shoulder, arm, or hand
Weakness in the arm or hand
Numbness or tingling in the fingers (especially the 4th and 5th fingers)
Impaired hand and finger dexterity
Symptoms worsen with arm elevation or overhead activities.
Venous TOS:
Swelling in the hand or arm
Heaviness in the arm or hand
Bluish discoloration of the hand
Prominent veins in the shoulder, arm, or hand
Blood clots in the veins of the upper extremity (effort thrombosis).
Arterial TOS:
Pain in the arm or hand
Coldness, paleness, and numbness in the fingers or hand
Weakness or fatigue in the arm
Poor circulation in the arm and hand
In severe cases, finger ulcerations or gangrene.
Causes
TOS is caused by compression of the nerves and/or blood vessels in the thoracic outlet. Factors that can contribute to this compression include:
Anatomical defects: Congenital abnormalities, such as an extra rib (cervical rib).
Trauma: Accidents, falls, or whiplash injuries.
Repetitive activities: Activities involving repetitive arm movements or overhead reaching.
Poor posture: Slouching or drooping shoulders.
Weight lifting: Can cause enlargement of surrounding muscules putting pressure in the area.
Pregnancy: Changes in body positioning or fluid retention can sometimes cause TOS.
Tumors: Rarely, a tumor in the thoracic outlet can compress nerves or blood vessels.
Medicine Used
Medications used to manage TOS symptoms may include:
Pain relievers: Over-the-counter pain relievers such as ibuprofen or naproxen, or prescription pain medications.
Muscle relaxants: To relieve muscle spasms.
Anti-inflammatory medications: Corticosteroids to reduce inflammation.
Anticoagulants (blood thinners): For Venous or Arterial TOS to prevent blood clots.
Nerve pain medications: Such as gabapentin or pregabalin, to relieve nerve pain.
Is Communicable
No, Thoracic Outlet Syndrome is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Precautions to help prevent or manage TOS include:
Maintaining good posture: Sit and stand with proper alignment.
Avoiding repetitive activities: Take breaks during activities that involve repetitive arm movements or overhead reaching.
Losing weight: If overweight, losing weight can reduce pressure on the thoracic outlet.
Strengthening and stretching exercises: Perform exercises to strengthen the shoulder and neck muscles and improve flexibility.
Proper lifting techniques: Use proper lifting techniques to avoid strain on the neck and shoulders.
Avoiding carrying heavy bags on the shoulder: Distribute weight evenly.
Ergonomic workstation setup: Ensure a proper workstation setup to minimize strain on the neck and shoulders.
How long does an outbreak last?
TOS is not an "outbreak" illness. The duration of symptoms varies greatly depending on the severity of the compression, the type of TOS, and the individual's response to treatment. Symptoms can be intermittent or constant. With appropriate treatment, including physical therapy and lifestyle modifications, symptoms can improve significantly or resolve. Without treatment, symptoms can persist and worsen over time.
How is it diagnosed?
Diagnosis of TOS typically involves a combination of:
Medical history and physical examination: Assessing symptoms, risk factors, and performing specific physical tests to evaluate nerve and blood vessel function.
Imaging studies:
X-rays: To identify bony abnormalities such as cervical ribs.
MRI: To visualize soft tissues, nerves, and blood vessels.
CT angiography or MR angiography: To evaluate blood vessel compression.
Ultrasound: To assess blood flow.
Nerve conduction studies (NCS) and electromyography (EMG): To evaluate nerve function (primarily for Neurogenic TOS).
Arteriography and venography: To assess blood flow in arteries and veins (primarily for Arterial and Venous TOS).
Timeline of Symptoms
The timeline of symptoms can vary greatly. Some individuals may experience sudden onset of symptoms after an injury, while others may have a gradual onset of symptoms over weeks, months, or even years. Symptoms can be intermittent at first and then become more constant over time. There is no one specific timeline for the progression of TOS symptoms.
Important Considerations
Early diagnosis and treatment are important to prevent long-term complications.
TOS can be difficult to diagnose, as symptoms can mimic other conditions.
Treatment options vary depending on the type and severity of TOS.
Surgery may be considered if conservative treatments are not effective, but it is not always necessary.
A multidisciplinary approach involving doctors, physical therapists, and other healthcare professionals is often beneficial.
Lifestyle modifications and preventative measures are crucial for managing TOS.
Venous and arterial TOS require immediate medical attention due to the risk of blood clots and other serious complications.