Thoracic outlet syndrome (TOS) is the term used for three, related, conditions in which pressure on blood vessels or nerves in the area between the neck and shoulder cause pain in this area. This pressure can also cause tingling, numbness and weakness down the arms and into the fingers.
This compression may be caused by:
A small additional rib near the collar bone,
An abnormal size or shape on the first rib,
Differences in the position of the scalene muscles of the neck,
A previous Clavicle (collar bone) fracture that may not have healed correctly
Common causes of these differences include trauma (such as a road traffic accident) and personal anatomy. Repetitive strain on the muscles from work or sport can also cause pressure from the muscles in this area.
There are three types of TOS:
- Neurogenic – In this type, a group of nerves called the brachial plexus is compressed. The nerves of the brachial plexus come from the spinal cord and control muscle movements and feeling in the shoulder, arm and hand.
- Venous – This type occurs when one or more of the veins under the collarbone are compressed and damaged. This can result in blood clots.
- Arterial –This is the least common type of TOS. It occurs when one of the arteries under the collarbone is compressed. The compression may cause injury to the artery resulting in a bulge, known as an aneurysm, or blood clot formation.
Symptoms and Signs of TOS:
Thoracic outlet syndrome symptoms can vary depending on the type.
When nerves are compressed, as in Neurogenic TOS, symptoms include:
- Numbness or tingling in the arm or fingers.
- Aches and pains in the neck, shoulder, arm or hand.
- Arm fatigue with activity.
- Weakening grip strength.
Symptoms of Venous TOS can include:
- Change in the colour of the hand or one or more fingers.
- Hand or arm pain and swelling.
Symptoms of Arterial TOS can include:
- A pulsating lump near the collarbone.
- Cold fingers, hands or arms.
- Hand and arm pain.
- A change in colour in one or more of the fingers or the entire hand.
- Weak or no pulse in the affected arm.
Diagnosis from your G.P. will lead to treatment that usually involves Physiotherapy and pain relief. Massage of the arms and hands can reduce pain, relax muscles and improve range of motion to help with the rehabilitation exercises. Most people improve with these treatments but, for some, surgery may be recommended to release the pressure.
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