Thoracic Outlet Syndrome (TOS)

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What is thoracic outlet syndrome?

Thoracic outlet syndrome is a condition whereby symptoms are produced from compression of nerves or blood vessels, or both, because of an inadequate passageway through an area (thoracic outlet) between the base of the neck and the armpit. The thoracic outlet is surrounded by muscle, bone, and other tissues. Any condition that results in enlargement or movement of the tissues of or near the thoracic outlet can cause the thoracic outlet syndrome. These conditions include muscle enlargement (such as from weight lifting), injuries, an extra rib from the neck at birth (cervical rib), weight gain, and tumors at the top of the lung (rare). Often no specific cause is found.

It is felt by some researchers that the evolution of the torso of primates from a four-legged to a two-legged position may predispose humans to the development of thoracic outlet syndrome. The resulting vertical posture produced flattening of the chest cage and a shift of the shoulder joint backward, both of which narrowed the thoracic outlet.

What are symptoms of thoracic outlet syndrome?

Symptoms include neck, shoulder, and arm pain, numbness, or impaired circulation to the extremities (causing discoloration). Often symptoms are reproduced when the arm is positioned above the shoulder or extended. Patients can have a wide spectrum of symptoms from mild and intermittent, to severe and constant. Pains can extend to the fingers and hands, causing weakness.



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Thoracic Outlet Syndrome - Symptoms Question: What were the symptoms of your thoracic outlet syndrome?
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Plumbing the Pits of Despair with Thoracic Outlet Syndrome

One patient's story

Author: Betty Kovacs, MS, RD
Medical Editor: Melissa Conrad Stöppler, MD

It took three years and three months, three MRI's, two x-rays, two EMG's, and nine health-care professionals for me to feel better. It was a journey that felt like forever with exhausting highs and lows. Each new doctor's appointment was entered into with hope and walked out of in despair. Those who were unable to diagnose my condition were able to make me think that it was all in my head. Fortunately, or unfortunately, my symptoms progressed and out of desperation I gave one last doctor a chance. That last chance saved my sanity and gave me back my life.

My symptoms started off somewhat vague. I had taken on a new position at work that required a lot of time on the computer. I began having pain on my right side in my neck and shoulder with tingling in my hand at the end of the day. I felt a lump on my cervical spine that I assumed to be the cause of the symptoms. I went to an orthopedic surgeon who sent me for an MRI to rule out a tumor. I was assured that he had never seen a tumor in that area, but that did not ease the heart-wrenching fear of a possible tumor. I soon learned that I did not have a tumor and that I was too claustrophobicto ever get back in an MRI machine. I was so relieved that I decided to wait and see if the symptoms went away on their own.

For the next year, I got massages and stopped lifting weightsto help with my pain. My outer three fingers on my hand had begun getting cold at the end of the day. As time went on, they would get cold after a few hours. I couldn't tell if the shoulder painwas causing the hand pain or vice versa. I went to a leading hand surgeon to figure out what was going on. The diagnosis was discomforting. I was told that this was simply a case of poor posture and that physical therapy (PT) would correct it. I have been tall my entire life, so my posture is a sensitive area. At 32 years of age, I did not expect to ever hear that I have to sit up straight again.

After much hesitation, I went to see a physical therapist that a friend had recommended. We explained my situation and asked if he could figure out the cause of my symptoms. He examined me and walked in with a book that showed an image of something called thoracic outlet syndrome(TOS). It was the first time that I felt that sense of relief that you get when something finally makes sense. I tried PT for three months and did not get relief from my symptoms. My physical therapist and I decided that I needed medical assistance with this.

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