THORACIC OUTLET
THORACIC OUTLET
Looking for a helpful guide to Thoracic Outlet? You’re in the right place! We’ve assembled this succinct and straight-forward guide to Thoracic Outlete packed with helpful information answering some of the most frequently asked questions regarding this health condition.
A GUIDE TO THORACIC OUTLET
As more and more people continue to work from computers, constantly text and do everything in the frontal plane we are seeing more cases of thoracic outlet pop up. What does this look like for the average person? Well, symptoms can be broad like pain, tingling or weakness in the shoulder and arm. These symptoms often occur when raising the arms. It is a compressive syndrome in which the nerves can become compressed. Often times patients will have a long history of pain. Find out more below about TOS and the types of veins/nerves that become compressed such as: neurogenic TOS, venous TOS, aterial TOS and sometimes vascular TOS.
WHAT IS THORACIC OUTLET?
The thoracic outlet is a name for the space around your first and second rib just underneath your collar bone. Thoracic outlet syndrome is a slightly broad term that is used to describe one of three different issues all caused by compression in this area. More than ninety percent of all people suffering from thoracic outlet syndrome receive a neurogenic diagnoses from compression on the brachial plexus nerve (a nerve that runs beneath the clavicle, and connects directly to cervical nerves in the neck, and the median nerve that runs down your arm into your hands).
If you or someone you know has been diagnosed with a vascular TOS it means that you have one of the following: Either a venous diagnosis that covers about 5 percent of cases from compression on the subclavian vein (a vein that lies directly on top of the first rib in the neck) or you’re in the one percentile of cases that have the arterial diagnosis from compression on the subclavian artery (an artery that lies on top of the first rib just above the subclavian vein.). Whether the issue is a compressed nerve or vein, it is very uncomfortable and even painful to deal with, and the pain and discomfort can travel further, down the arm and even to the wrist and hand. It can increase your chances of blood clots and make tasks in which you must reach overhead more difficult.
WHAT CAUSES THORACIC OUTLET?
As we explained earlier TOS comes from compression in either the brachial plexus nerve, the subclavian vein, or the subclavian artery. How though, does this compression occur in the first place? If you’re familiar with anatomy you may know that your ribs are attached to your thoracic spine meaning that you have twelve ribs all attached to you twelve thoracic vertebrae. A lesser known fact however, is that a small portion of the population (about one to three percent) also have a cervical rib! This rib is normally not even noticed considering it’s normally so small that not even an x-ray would show it. In the unlucky few where it does fully form and grow it can be the culprit behind the compression. Other abnormalities that can cause TOS come in the form of an extra scalene muscle (a muscle in the neck) or oddly formed/shaped first rib or clavicle.
Other ways of developing TOS are whiplash, a trauma like this could leave you in pain initially and that is to be expected however if you have chronic pain running down your shoulder and arm after this experience you could have TOS. Bodybuilding: if the muscles in your neck grow too large even though you may look great it could also cause the compression that leads to your discomfort. Weight gain in general even if it's not from bodybuilding the added mass could cause compression. In small populations a tumor may be the culprit.
WHAT ARE SYMPTOMS OF THORACIC OUTLET?
The symptoms of TOS are highly dependent on the type of TOS you may be suffering from. As you may imagine, compression of different structures of the body feels different and determines how far these symptoms travel. If you happen to be dealing with neurogenic compression then the symptoms include:
- Pain and discomfort in the shoulder and arm.
- Tingling in the forearm, wrist, and hand.
- You could feel weakness or that your shoulder and arm are quick to fatigue.
- In some rare occasions, you may also have some atrophy (shrinking, and weakening) that usually occurs in the base of the thumb.
These symptoms will typically be intermittent and seem to be exacerbated during activities involving placing the arms overhead.
Venous compression could cause effort thrombosis and form blood clots, these clots are the main cause of the symptoms you may feel, which include:
- The veins in your neck, shoulder, and arm could grow unusually large.
- Swelling that occurs in the arm, hand, and even in the fingers.
- Your hand and arm could also turn blue!
- Again tingling in the forearm, wrist, and hand.
Then there’s an arterial compression that can cause an embolism, or an aneurysm that would have to be further inspected by a medical professional. This is often accompanied by:
- Your hand turning pale and cold to the touch
- Reaching or working with your hands overhead will be painful.
HOW DO YOU TREAT THORACIC OUTLET?
Treatment also depends on the form of TOS you are dealing with. The first form of treatment prescribed for a patient suffering from compression on the brachial plexus nerve will be physical therapy especially for those who’s symptoms were brought on by bodybuilding or a job. If you have recently gained weight not related to the gym you may have a dietary intervention to aid with a loss of mass. If symptoms persist for months after physical therapy you will likely be recommended to get a Botulinum toxin shot. The last resort in this circumstance would be surgery to remove a rib or cut a muscle. Unfortunately some people find that there was a misdiagnosis and none of these will help leaving you still in pain after all this is done.
When dealing with either venous or arterial TOS surgery is actually the most prominent recommendation from doctors. The surgery would likely be to remove the scalene muscles, first rib, and if you happen to have one, the cervical rib will be removed as well. In venous TOS they may go in a second time a few weeks after your initial surgery to remove clotting or open the vein using a balloon. In arterial TOS reconstruction or even replacement of an artery may be necessary. Other forms of treatments include medication such as blood thinners to get rid of clotting.
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