The common symptoms of thoracic outlet syndrome include pain, tingling, and numbness of your neck, arms, shoulders, and hands. It also involves swelling, weakness like losing your grip, and abnormal changes in the color of your fingers. Due to compression, there’s a blood flow restriction to your brain, which causes headaches, vertigo, and other similar symptoms. However, these symptoms are often overlooked when diagnosing the condition.
I’ve watched many medical tv series and would always hear about the word “thoracic.” I’ve noticed that term would pop up whenever a patient in those movies I watch got in an accident, mostly vehicular accidents or from playing sports.
“Thoracic” describes anything involving your thorax, commonly known as your chest. It’s the region between your neck and abdomen.
So whenever there’s an issue or, say, a medical condition in your chest, your doctor will use the word “thoracic.”
A lot of problems can occur in your chest; one popular is known as thoracic outlet syndrome (TOS)
What causes thoracic outlet syndrome?
Thoracic outlet syndrome occurs when blood vessels (artery or vein) or nerves on the thoracic outlet experience continuous compression.
The thoracic outlet is located just above your first rib and behind your collarbone (clavicle).
It’s a very narrow space or passageway where blood vessels, nerves, and muscles extending from your neck to your arms pass through.
Sometimes, doctors don’t always know what causes the compression in your thoracic outlet.
However, it may result due to the following conditions:
- An extra rib. An extra cervical rib can increase the odds of nerves and blood vessel compression in the thoracic outlet.
- Poor posture and obesity. These can put pressure on the thoracic outlet, narrowing the tiny passageway.
- Injury. Vehicular accidents or any other traumatic injuries can cause internal damage, which may compress the thoracic outlet and the nerves in this area.
- Weightlifting. It may cause the muscles in your neck area to build up too much, which causes the nerves or blood vessels to compress.
- Repetitive use of hands or shoulders. Activities that require overhead repetitive motions may damage the tissues in your thoracic outlet and cause the area to shrink.
- Neck tumor. In very rare cases, a tumor may cause compression.
What are the symptoms of thoracic outlet syndrome?
There are three types of thoracic outlet syndrome. And symptoms vary according to each type.
Below are the following:
1. Neurogenic thoracic outlet syndrome
Compressed nerves may cause the following symptoms:
- Pain in your neck, shoulder, arm, or hand
- Weakness of the arm or hand
- Numbness, tingling, or discomfort in the forearm and fingers
- Shrinking of the size and weakness of the pad of your thumb (atrophy)
Symptoms would come and go but usually worsens when arms are held up.
2. Veinous thoracic outlet syndrome
Compressed veins may cause the following symptoms:
- Swelling and pain in the arm, hand, or fingers
- Discoloration of the hand or arm, which becomes bluish
- Fingers become pale or change in abnormal color
- Painful lump near your collarbone
- Blood clots (veins become prominent) in your shoulder, neck, and hand
3. Arterial thoracic outlet syndrome
Compressed arteries may cause the following symptoms:
- Cold and pale hands or arms
- Hand and arm pain that worsens during overhead motions of the arm
- Fingers or hands become pale or change to a bluish color
- Your affected arm shows no or very weak pulse (embolism)
- Aneurysm or bulging of the artery in your upper thorax (subclavian artery)
When the subclavian arteries are compressed, the blood flowing to your brain may become restricted, giving you symptoms like headaches, migraines, dizziness, light sensitivity, vertigo, lightheadedness, and other similar symptoms.
Headaches are a common symptom of thoracic outlet syndrome but are often overlooked.
Patients with neurogenic TOS typically experience headaches at the back of their heads. Many patients with compressed nerves would also experience migraine headaches, but there’s no clear explanation for why it occurs.
How do you calm down thoracic outlet syndrome?
When the disorder is diagnosed early, your doctor might recommend you follow first-line treatments to ease symptoms and pain.
It may include the following:
1. Take over-the-counter medications
Pain relievers like naproxen or ibuprofen may help reduce pain and inflammation caused by compression.
2. Take prescription medications
Your doctor may prescribe clot-busting (thrombolytics) or blood-thinning (anticoagulants) drugs to dissolve blood clots and prevent them from forming and restricting the blood flow in the thoracic outlet.
3. Go to physical therapy
Exercise stretching and strengthening your shoulder muscles will open your thoracic outlet, support your collarbone and muscles in the thoracic outlet, improve your range of motion, and restore your normal posture.
Pressure due to compression of blood vessels and nerves in the thoracic area may come off when physical therapy is done over time.
Talk to your doctor about referring a therapist whose area of expertise or who’s had experience in treating patients with TOS.
4. Lose weight
Your doctor may recommend a healthy diet and weight loss plan to reduce your weight to normal.
Having a healthy weight will prevent pressure from occurring in your joints which can affect the muscles, nerves, or blood vessels in your thoracic outlet.
5. Quit smoking and alcohol
Smoking and drinking too much alcohol can increase inflammatory levels in your body, which can worsen your symptoms.
6. Eat anti-inflammatory foods
Foods that can reduce inflammation may help relieve symptoms and prevent chronic inflammation.
You should follow an anti-inflammatory diet. It involves eating various fruits, green leafy vegetables, spices and herbs, nuts and seeds, whole grains, fatty fish, organic meat, and healthy oils.
7. Exercise regularly
Ask your doctor about an exercise plan, especially because some exercises, like lifting weights and bodybuilding, can worsen your symptoms.
Create an exercise routine that involves rest days and not too much heavy lifting.
8. Manage stress
Practicing daily stress management can prevent flare-ups of symptoms.
Any physical or emotional stress can cause blood flow restriction, exacerbating your symptoms.
9. Avoid very hot and cold temperatures
These may cause more tingling and color changes in your arms or hands.
10. Apply heat or ice
A cold compress or heat pads on the painful, affected area may help reduce pain and swelling.
11. Massage your shoulders
Massaging your shoulders and the thoracic outlet gently and properly may help reduce tension and relieve tingling and pain.
12. Fix your work setup
Changing your workstation to help you maintain a good posture without hunching over too much, especially when you work a desk for long hours, will prevent worsening symptoms.
Consider using a standing desk or following an ergonomic workstation setup.
When do you need surgery?
When other treatments don’t improve your condition, or they seem to worsen your symptoms, your doctor may suggest a surgical procedure.
Surgery for thoracic outlet syndrome is known as thoracic outlet decompression.
It involves different methods and approaches, which vary from case to case. But, typically, your surgeon will remove a section of your first rib to relieve the compression and, in some cases, may also remove a part of the muscle in your neck (scalene muscle).
Sometimes, surgery can put you at risk of an injury and may even cause symptoms to recur.
What can worsen thoracic outlet syndrome?
Many patients with thoracic outlet syndrome, especially those with neurogenic TOS, experience recurring symptoms when they elevate their hands or overuse them too much.
Activities that trigger symptoms of TOS include the following:
- Outstretching your arms to reach or lift an object
- Throwing or catching
- Working on the computer or typing for long hours
- Driving a motor vehicle
- Holding or scrolling on the phone
- Combing, brushing, or drying your hair
- Lying flat on your back when sleeping while your arms are overhead
What tests diagnose thoracic outlet syndrome?
Diagnosing thoracic outlet syndrome involves a physical examination, medical history, imaging, and nerve study tests.
Because TOS can show symptoms similar to other health conditions, your doctor may have difficulty diagnosing the disorder.
The following are the tests that you may undergo:
- Ultrasound. It can reveal vascular problems.
- X-ray. This will show if you have an extra rib.
- Computerized tomography (CT Scan). Your doctor will use a dye to show a clearer view of your blood vessels which will help them locate the compression.
- Magnetic resonance imaging (MRI). It provides a clearer view of your body which helps doctors locate and see the cause of vascular compression.
- Arteriography or venography. Using a tube known as a catheter, your doctor will check if you have a compressed artery or vein or a blood clot.
- Electromyography. It will identify if you have nerve damage.
Many people with thoracic outlet syndrome describe experiencing abnormal tingling, burning, or prickling sensations (paresthesia) in their neck, arms, shoulders, and hands.
So, your doctor may test the function of the nerves in your neck and arms if you present such symptoms.
Sometimes, your doctor might perform a scalene muscle block test to see if your symptoms improve.
Can thoracic outlet syndrome cause stroke?
In very rare cases, thoracic outlet syndrome can lead to stroke. TOS can potentially aggravate some common triggers that lead to stroke.
Thoracic outlet syndrome (TOS) can display various signs and symptoms that could be mistaken as another health condition.
Your doctor will give you different diagnostic tests to know what’s causing your symptoms.
If you suspect TOS is causing your symptoms like pain, tingling, numbness, swelling with dizziness, headaches, and vertigo, you should prevent activities that can cause more tension in your neck, shoulders, and arms.
Always maintain a good posture, avoid heavy lifting, take pain medicines, manage stress, apply ice or heat pads, and gently massage the affected area.