A Thoracic Outlet is a passageway located in the upper chest between the base of the neck and armpits (the area between the ribs and collarbone).
The passageway is a way out / passed nerves (brachial plexus) and blood vessels (arteries and veins subclavian).
Thoracic Outlet Syndrome (TOS) is a condition in which compression / suppression of nerves and/or blood vessels occurs in thoracic outlets, with symptoms of numbness and tingling in the fingers, pain in the shoulders, arms, and neck.
Thoracic Outlet Syndrome Types
Thoracic outlet syndrome is a disorder group that occur when the blood vessels or nerves between the collarbone and first ribs are depressed. This condition can trigger pain in the neck and shoulders as well as numbness in the fingers. From the cause, thoracic outlet syndrome is divided into two types, namely:
- Neurogenic (neurological) thoracic outlet syndrome
- Vascular thoracic outlet syndrome
Thoracic Outlet Syndrome Causes
Any condition that causes enlargement of muscles and tissues located near thoracic outlets and causes exposure or suppression of blood vessels and or nerves in the area, can be the cause of thoracic outlet syndrome.
Some conditions or activities that can trigger muscle enlargement and cause clamping of nerve and or blood vessels in the chest outlet area include
- Heavy lifting activities,
- Sports that often use the upper arm to throw or hit include swimming, especially with freestyle, butterfly style, and backstroke,
- Water polo,
- Tennis players and all athletes who in each of their activities place repeated stress on the shoulders with extreme movement and external rotation of the shoulders (overhead activities), and weight gain.
Other causes of chest outlet/TOS syndrome are injuries (physical trauma from car accidents), repetitive injuries due to work and or related to sports activities, diseases or tumors in the upper part of the lungs, or congenital problems, such as abnormalities in the first rib cage or having elongated ribs.
Sometimes doctors can’t determine the cause of the chest outlet syndrome.
Thoracic Outlet Syndrome Symptoms
What are the thoracic outlet syndrome symptoms and signs?
The disease can affect blood vessels or nerves. But in most cases only nerves are affected. Symptoms include pain in the shoulders, arms, or hands, or all three. Sore hands are usually on the ring finger and pinkie. The fingers may be numb and tingling, the grip weakens. The pain often worsens every move of the arm, and often feels tired on the part of the hand.
Arteries or veins are less affected. After all, depending on the type of artery or vein, symptoms will vary. The pinched part of the artery will cause the skin to discolor, cold arms, and numbness. Pressing on the veins of the arm causes swelling and pain.
Some other symptoms or signs may not be listed above. If you feel anxious about these symptoms, consult your doctor immediately.
When should I see a doctor?
Contact your doctor if:
- Pain in the arm
- Cold and pale fingers
- Numbness and swelling of the arms.
Thoracic Outlet Syndrome Treatment
Treatment options for chest outlet syndrome focus on reducing symptoms such as pain and numbness. The specific treatment that the doctor recommends will depend on the type and cause of the person’s condition.
The sections below discuss treatment options for thoracic outlet syndrome in more detail.
Physical therapy can help strengthen and increase flexibility in the shoulder and neck muscles. Doctors may recommend physical therapy for all types of thoracic outlet syndrome, but it may offer significant benefits for people with poor posture.
Combining endurance exercises and shoulder stretching will strengthen the shoulder and neck muscles, which can help dilate the chest exit and reduce pressure from blood vessels and nerves.
Taking over-the-counter anti-inflammatory drugs, such as ibuprofen or naproxen (Aleve), can help reduce swelling and relieve pain.
The doctor may also administer thrombolytic medications to break down blood clots in veins or arteries. People who have a chest outlet syndrome due to blood clots can use anticoagulants to prevent the formation of clots in the future.
A person may require surgery if the symptoms do not improve with treatment and physical therapy.
Surgery for thoracic outlet syndrome usually involves the removal of the first part of the rib cage and, in some cases, the removal of part of the unequal side muscles.
A surgeon may need to perform vascular reconstruction to a damaged artery or vein. Vascular reconstruction involves replacing damaged blood vessels with new vessels, called grafts. Surgeons can use synthetic grafts or tissue grafts, which contain the person’s own tissue or donor tissue.
People with the chest outlet syndrome can work with a physical therapist to build a personalized treatment plan consisting of optimal exercise and stretching for their symptoms.
Examples of shoulder gymnastics that can be tried to relieve the symptoms of chest outlet syndrome include:
Raise your arms
- Stand upright with open legs as wide as your hips and relaxing arms.
- Hold one small load in both hands.
- Contract the abdominal muscles and lift the arms until they are parallel to the shoulders, creating a T-shape.
- Lower the arm back gently to its original position.
- Contract the abdominal muscles and lift the arms in front of the body until they are aligned with the shoulders.
Pull shoulders while standing
- Find the cable machine and lower the cable to shoulder height.
- Stand in front of the cable machine, hold the cables, one in each hand, and step back until the arms are straight in front of the body and parallel to the shoulders.
- Make sure the back of the hand is facing the ceiling.
- Gently pull the cable towards the body by bending the elbow and pulling to the side of the rib cage.
- Hold for 1 or 2 seconds and release gently, returning to the starting position.
- Sit or stand with your arms on the side and back straight.
- Squeeze the shoulder blades together and hold for 3–5 seconds.
- Relax your shoulders.