TOS presents with a wide range of symptoms which greatly vary with the nature of compression involved. It has been observed that nerve compression produces more symptoms than when blood vessels are compressed.

When nerve compression occurs, individuals experience pain in the back, neck and shoulders. Development of weakness is a common phenomenon in such cases which eventually leads to weak grip. In addition, affected individuals also complain of tingling sensation and numbness in the 4th and 5th fingers.

Blood vessel compression gives rise to inflammation of the arms accompanied by redness of the affected area. This basically occurs as the blood supply to the affected area is grossly reduced. As a result, the affected arm becomes cool and fatigued.

• Pain

  These symptoms are sometimes accompanied by headache, neck pain, shoulder and back muscle tightness or chest discomfort. Besides Thoracic Outlet Syndrome, many other processes can cause neck, shoulder, and arm pain. [vascularinstitute.com]

  Patients may have sudden pain, weakness, numbness, and/or tingling in their hands, and they almost always require surgery. [med.stanford.edu]

  Sign Up for FREE to spineadvisor, SpineUniverse's monthly eNewsletter and receive back and neck pain news, treatment updates, and lifestyle tips on managing your pain. No, thanks. Please take me back to the article. [spineuniverse.com]

  3 hours that resolved spontaneously; and 1 patient fell at home, with transient increased pain in the surgically treated extremity. [ncbi.nlm.nih.gov]

  The pain of thoracic outlet syndrome is sometimes confused with the pain of angina that indicates heart problems. [medical-dictionary.thefreedictionary.com]

• Weakness

  Patients may have sudden pain, weakness, numbness, and/or tingling in their hands, and they almost always require surgery. [med.stanford.edu]

  The disorder can sometimes be diagnosed in a physical exam by tenderness in the supraclavicular area, weakness and/or a "pins and needles" feeling when elevating the hands, weakness in the fifth ("little") finger, and paleness in the palm of one or both [ninds.nih.gov]

  BACKGROUND: Neurogenic thoracic outlet syndrome is an underestimated cause of brachial weakness and pain. [ncbi.nlm.nih.gov]

  Peer Reviewed Page: 1 of 3 Pain, numbness, tingling, and weakness in your upper extremities may be a result of thoracic outlet syndrome (TOS). [spineuniverse.com]

  Symptoms include weakness or numbness of the hand, decreased size of hand muscles which usually occurs on one side of the body, pain, tingling, prickling, numbness and weakness of the neck, chest, and arms. [medstargoodsam.org]

• Arm Pain

  Signs & Symptoms: Neck/shoulder/arm pain, paraesthesia or numbness in arms/fingers, impaired circulation to the extremities. [corehealthcare.com.au]

  We report a case of a 17-year-old female volleyball player who presented with months of chronic arm pain. Radiographic imaging demonstrated nonunion fracture of the first rib. [ncbi.nlm.nih.gov]

  Symptoms of thoracic outlet syndrome TOS may cause: Neck, shoulder or arm pain Numbness in the arm, hand or fingers Impaired circulation to the extremities (causing discoloration) Weakness in the shoulders, arm, and hands Swelling of the entire arm and [ucdmc.ucdavis.edu]

  Snapshot A 25-year-old woman with no history of trauma presents with right arm pain. She reports that her right arm is easily fatigable, especially after she cooks. [step1.medbullets.com]

  The increased pressure on the blood vessels and nerves may cause pain in your shoulders, neck and arms. It also can cause numbness or tingling in your fingers. [uncmedicalcenter.org]

• Falling

  Neurogenic thoracic outlet syndrome can also develop in people who experience trauma to the neck or chest from a car accident or a fall. [nyulangone.org]

  "You have to fall in love with the process." [espn.com]

  'Blood Clots' Cause Tamar Braxton to Quit 'Dancing With the Stars' ‘Dancing With the Stars’ 2015: Alexa PenaVega Booted From Ballroom, Tamar Braxton Falls Ill, Misses 1st Dance However after the blood clots cleared, there was more medical drama for the [abcnews.go.com]

  Everyone has had the experience that resting the inside of their elbow on a hard surface for a long period of time will cause the typical numbness and pins and needles to radiate into the outside of the hand as the hand “falls asleep”. [neckandback.com]

  Harding, the Wild goalie, was diagnosed with multiple sclerosis last fall and missed 33 games as he underwent treatment. He returned to the lineup in late April. [bostonglobe.com]

• Raynaud Syndrome

  Rare complications of thoracic outlet compression syndromes include Raynaud syndrome localized to the affected arm and distal gangrene. [merckmanuals.com]

  The patient can also develop weakness in the arm and hands, tingling nerve sensations, and a condition called Raynaud's syndrome. In Raynaud's syndrome, exposure to cold causes small arteries in the fingers to contract, cutting off blood flow. [medical-dictionary.thefreedictionary.com]

• Thrombosis

  Symptoms Symptoms of venous TOS are caused by subclavian vein thrombosis and/or stenosis. [vascular.surgery.ucsf.edu]

  The upper extremity is an uncommon site for deep vein thrombosis and, although most of these thrombotic events are secondary to catheters or indwelling devices, venous thoracic outlet syndrome is an important cause of primary thrombosis. [ncbi.nlm.nih.gov]

• Vascular Disease

  View vascular disease patient stories, including stories about thoracic outlet syndrome patients. [umm.edu]

  disease or other vascular disorders. [journals.lww.com]

• Shoulder Pain

  Thoracic outlet syndrome is a controversial cause of neck and shoulder pain due to complex mechanisms involving muscular dysfunction and nerve compression. [ncbi.nlm.nih.gov]

• Neck Pain

  Sign Up for FREE to spineadvisor, SpineUniverse's monthly eNewsletter and receive back and neck pain news, treatment updates, and lifestyle tips on managing your pain. No, thanks. Please take me back to the article. [spineuniverse.com]

  Symptoms of thoracic outlet syndrome Neurogenic thoracic outlet syndrome – Symptoms include pain, numbness and weakness in your arm or hand Venous thoracic outlet syndrome – Symptoms include swelling, dark discoloration of the arm and neck pain. [wexnermedical.osu.edu]

  NTOS is an underappreciated and often overlooked cause of shoulder and neck pain and numbness. [practicalpainmanagement.com]

  Other symptoms include pain and weakness or tiredness of the arm that increases with work done overhead. Some people may experience neck pain or headaches in the base of their head. [physiofix.com.au]

  Thoracic outlet syndrome symptoms include: neck pain, shoulder pain, arm pain, numbness and tingling of the fingers, impaired circulation to the extremities (causing discoloration, swelling, or pain) Diagnosis of thoracic outlet syndrome is suggested [childrenshospital.org]

• Cervical Rib Syndrome

  […] outlet syndrome, venous Venous thoracic outlet syndrome 353.0 Excludes Applies To Cervical rib syndrome Costoclavicular syndrome Scalenus anticus syndrome Thoracic outlet syndrome ICD-9-CM Volume 2 Index entries containing back-references to 353.0 : [icd9data.com]

  […] limbs, paresthesia of fingers, vasomotor symptoms, and weakness and wasting of small muscles of the hand; it may be caused by drooping shoulder girdle, a cervical rib ( cervical rib syndrome ) or fibrous band, an abnormal first rib, continual hyperabduction [medical-dictionary.thefreedictionary.com]

  For example, “cervical rib syndrome” is a type of thoracic outlet syndrome that can happen if a person has an extra upper rib. Experts also sometimes categorize thoracic outlet syndrome by the structures compressed. [cedars-sinai.edu]

  For example, “cervical rib syndrome” refers to a type of thoracic outlet syndrome that can happen if a person has an extra upper rib. Clinicians also sometimes categorize thoracic outlet syndrome according to the structures compressed. [cedars-sinai.org]

• Swelling of Hand

  Often fatigue of the arm and hand develops with use. Sometimes there is a band-like tightness around the biceps muscle. There may be a feeling as though the hand swells. Both hand and arm may feel cold as though there is decreased circulation. [vascularinstitute.com]

• Neck Weakness

  Your provider will listen to your history and will examine your neck, shoulder, arm and hand. There may be swelling, weakness or numbness in your hand or arm. You may have tightness in your neck. [summitmedicalgroup.com]

• Tingling

  The resulting scar tissue may cause pain, numbness, tingling, headaches, or weakness in the arm and hand. [nyulangone.org]

  Patients may have sudden pain, weakness, numbness, and/or tingling in their hands, and they almost always require surgery. [med.stanford.edu]

  It also can cause numbness or tingling in your fingers. The initial treatment for TOS typically consists of physical therapy, pain relief measures including medication and occasionally blood thinning medications in case a clot is detected. [uncmedicalcenter.org]

  Symptoms of thoracic outlet syndrome may include: Pain, numbness, and tingling in the pinky and ring fingers, and the inner forearm Pain and tingling in the neck and shoulders (carrying something heavy may make the pain worse) Signs of poor circulation [nlm.nih.gov]

  It causes pain in the neck and shoulder, numbness and tingling in the fingers, and a weak grip. [umm.edu]

• Paresthesia

  In addition to the typical symptoms of arm swelling and paresthesias, headaches have been reported as a potential symptom of TOS. [ncbi.nlm.nih.gov]

  For true NTOS surgical decompression is considered based on the degree of nerve injury and is indicated if there is acute or sub-acute progressive weakness or disabling pain and paresthesias. [orpha.net]

  Other symptoms include paresthesias (pins and needles sensation or numbness) in the fingers and hand, change in hand color, hand coldness, or dull aching pain in the neck, shoulder, and armpit. [ninds.nih.gov]

• Confusion

  The pain of TOS is sometimes confused with the pain of angina (chest pain due to an inadequate supply of oxygen to the heart muscle), but the two conditions can be distinguished because the pain of thoracic outlet syndrome does not occur or increase when [my.clevelandclinic.org]

  The responsability of recognizing TOS falls both on the doctor who cures: avoiding confusions as it concerns the diagnosis and the therapeutic indication by finding the correct, clinical diagnosis, and the patient: recovering and avoiding severe complications [tmj.ro]

  The primary controversy seems to center around the lack of objective criteria for diagnosis and the confusion with multiple types or clinical presentations. [emedicine.medscape.com]

• Numbness of the Hand

  Symptoms include weakness or numbness of the hand, decreased size of hand muscles which usually occurs on one side of the body, pain, tingling, prickling, numbness and weakness of the neck, chest, and arms. [medstargoodsam.org]

  Symptoms include weakness or numbness of the hand; decreased size of hand muscles, which usually occurs on one side of the body; and/or pain, tingling, prickling, numbness and weakness of the neck, chest, and arms. [my.clevelandclinic.org]

  They can include: Tingling or numbness in the fingers, hands, arm, shoulder or neck. Weakness of the hand or arm. Hand or arm swelling. Aching in the shoulder or neck. Symptoms may be worse when the arm is lifted above shoulder height. [summitmedicalgroup.com]

• Paresis

  Clinical features may include pain in the shoulder and neck region which radiates into the arm, PARESIS or PARALYSIS of brachial plexus innervated muscles, PARESTHESIA, loss of sensation, reduction of arterial pulses in the affected extremity, ISCHEMIA [fpnotebook.com]

  Most people report paresthesias (tingling or prickling), pain in the arm, and paresis (muscular weakness caused by nerve damage). [morphopedics.wikidot.com]

  The person affected by TOS may experience pain affecting the shoulder and neck region and also radiating into the arm; paresis or paralysis of muscles innervated by the brachial plexus; and altered sensation. [doi.org]

The following methods are employed to diagnose TOS:

• Physical examination: A detailed medical history along with a thorough physical examination to evaluate the signs and symptoms is carried out. The arms and hands are evaluated in several positions to arrive at a definitive conclusion.
• Elevate arm stress test: In this method, the individuals are asked to raise their arms over the head for about 3 minutes. During this period, they are also asked to alternatively open and close their fists. If symptoms occur during this activity it is an indication of TOS.
• Imaging studies such as CT scan, MRI, ultrasound and x-ray of the bones, blood vessels are carried out to diagnose the condition [7].
• Other tests such as blood circulation tests and nerve conduction tests also form an important part of the diagnostic procedures [8].

Efforts are channelized to treat TOS with conservative treatment at the initial level. If the disease is diagnosed in the preliminary stages then medications and exercises should be employed. Medications such as pain killers and antiinflammatory drugs are prescribed for reducing the swelling and pain. Regular exercising strengthens the muscles and gradually reduces the pressure exerted on the nerves or blood vessels.

Surgery is the treatment of choice if other modes of treatment have failed to yield positive results [9]. Surgical intervention is employed to correct structural deformities or relieve the nerves or blood vessels from the pressure [10].

In majority of the cases, the prognosis is favorable only after surgical procedures to correct the anatomical defects are carried out. In case of physical trauma too, surgery is an effective option. However, there have been instances when patients have reported recurrence of symptoms even after treatment [6].

Compression of the nerves between the collarbone and the first rib is the major cause of TOS. The nerve compression can occur due to the following reasons:

• Physical trauma: Car accidents are one of the major causes of nerve compression. Physical trauma can lead to internal changes that cause the nerves or the blood vessels in the thoracic outlet to get compressed.
• Structural defects: Certain type of congenital defects in the anatomical features can also give rise to nerve compression. Presence of an extra rib or tight fibrous band that connects the spine to rib also causes TOS [3].
• Postural defects: Poor posture habits such as drooping shoulders or keeping the head in forward position can predispose an individual to develop nerve compression.
• Sports: TOS is also thought to be a common phenomenon in athletes who regularly participate in sports that force them to undergo repetitive movements using their arms and shoulders. Such a condition can cause wear and tear of the tissue leading to nerve compression.

The exact incidence of TOS is not known. However, with the available data, it can be estimated that such a type of condition occurs in 3 – 80 cases per 1000 population. TOS is more prevalent in women probably due to poor muscular development, poor posture or anatomical defects in this gender [4].

The thoracic outlet is basically the space between collarbone and first rib. In this space, there are numerous blood vessels, nerves and muscles. In conditions, when the muscles of the shoulder are unable to support the collarbone it may slip from its original position thereby exerting pressure on the nerves, muscles as well as the blood vessels. Such series of events give rise to various symptoms such as pain in the arm, shoulder and neck accompanied by numbness and tingling sensation in the fingers. These are the characteristic features of thoracic outlet syndrome [5].

The onset of TOS cannot be prevented. However the development of debilitating complications can certainly be prevented by following certain simple steps. Individuals experiencing symptoms of TOS are advised to religiously exercise to avoid extra pressure on already compressed nerves. The practice of carrying heavy bags on shoulder should also be discontinued to avoid increase in pressure on the thoracic outlet.

Thoracic outlet syndrome (TOS) is more common in women than men and strikes individuals between 20 to 50 years of age. In addition to the pain in the affected region, the condition can also cause development of tingling sensation in the fingers accompanied by numbness. Physical trauma, repeated injuries, structural abnormalities or physiological conditions such as pregnancy can lead to development of TOS [2].

Definition

Thoracic outlet syndrome (TOS) is characterized by development of pain in the arm, shoulder and neck due to nerve compression in the thoracic outlet. It is a common phenomenon for women and athletes. The age of onset of the disease condition is 20 – 50 years.

Cause

Nerve or blood vessel compression due to repeated pressure on the thoracic outlet is the sole reason for development of TOS. Physical trauma, structural abnormalities or any underlying disease condition causes the nerves to compress giving rise to debilitating symptoms.

Symptoms

Individuals with TOS experience pain in the neck, shoulder and the arms. They also complain of tingling sensation accompanied by numbness in the fingers. In such individuals the arm movement gets limited which makes it pretty difficult to carry out daily tasks.

Diagnosis

Diagnosis of TOS is made after a thorough preliminary physical examination is carried out to carefully study the symptoms reported by the individual. In addition, an elevated stress arm tests is also done to confirm the diagnosis. Imaging studies such as CT scan, MRI, ultrasound and x-ray of the bone are carried out to study the extent of nerve compression.

Treatment

If TOS is diagnosed in the preliminary stages, then conservative approach is enough to treat the condition. Medications and exercises have proven to be beneficial for patients with TOS. However when these fail to show any effect then surgical intervention to relieve the nerve compression is carried out.

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