Thoracic Outlet Syndrome

Hand and arm pain are often caused by a problem further up the body. Sometimes a nerve gets trapped around its exit from the spinal cord in the neck, and sometimes the problem is around the shoulder. Thoracic outlet syndrome (TOS) involves an area at the top of the chest between the first rib and collar bone.

What is Thoracic Outlet Syndrome?

TOS is the compression or irritation of a blood vessel, nerve, or rarely both simultaneously. The image above shows the thoracic outlet: the small space through which these structures have to pass. Because of the anatomy in this area, these vessels and nerves are more likely to be compressed around this point. Estimates of its incidence vary widely, with somewhere between 0.3-8% of the population affected.

Symptoms TOS

In some of the areas highlighted above, you may experience:

  • sharp or dull pain
  • numbness
  • weakness
  • pins and needles

In more chronic cases, some of the muscles in the arm or hand may begin to waste.

Vascular Symptoms

Roughly 10% of TOS cases are vascular. Alongside the above symptoms, you should take note of any symptoms that suggest a blood vessel may be compressed. These include:

  • the hand becoming cold to the touch
  • skin in the affected area turning pale or blue

Potential Causes

The space through which the nerves and vessels pass is quite small at best. It becomes smaller still when nearby muscles are tight, which can be the result of a chronically hunched posture. Hunching over your desk, for example, encourages the muscles around the chest to shorten and tighten. Over time this can lead to the development of TOS symptoms.

Everyone’s anatomy is slightly different, and some people have an extra rib at the base of the neck. This accounts for about 1/200 people. Most people with a cervical rib will never know about it, but it is possible that it could add to compression around the thoracic outlet and cause arm symptoms. This might be particularly relevant to you if you have a family history of similar symptoms, as the development of the extra rib is likely to be genetic.

Cases may be diagnosed in clinic with basic movement-based tests. For simple cases this will be sufficient for management, but more persistent cases may warrant imaging via your GP.

Managing Thoracic Outlet Syndrome

Mild cases of TOS may be managed conservatively, such as through exercises and hands on treatment. When the root cause is down to tight muscles and associated postural issues, your osteopath can help. Releasing the muscles through treatment and exercise can give quick effects. We will look at the rest of the body too, and typically find that the upper back needs some help too. Strengthening often forms part of the puzzle here, which helps to keep the shoulders from hunching over in the longer term too.

If you have symptoms of vascular TOS, you should speak to your GP before seeing your osteopath. Do so urgently if you have persistent symptoms, or find that your vascular symptoms come with significant weakness in the hand. Very rarely, venous TOS is associated with the development of a blood clot around the thoracic outlet. Call 999 if you develop chest pain or difficulty breathing.

Make an appointment in Alsager on 077 7593 1609