Thoracic Outlet Syndrome (cont.)

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What causes thoracic outlet syndrome?

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An inadequate passageway for nerves and blood vessels as they pass through an area (thoracic outlet) between the base of the neck and the armpit causes thoracic outlet syndrome. This can be constant or intermittent. Thoracic outlet syndrome can be caused by weight lifting, obesity, tumors in the chest, and extra ribs extending from the seventh cervical vertebra at the base of the neck.

What are thoracic outlet syndrome risk factors?

Risk factors include occupations that involve heavy usage of the upper extremities against resistance, including jack-hammer operators and dental hygienists, weight lifting, pregnancy, and obesity. Any condition that causes encroachment of the space for the brachial plexus at the thoracic outlet can lead to thoracic outlet syndrome.

What are thoracic outlet syndrome symptoms and signs?

Symptoms include neck, shoulder, and arm pain, numbness in the fingers, or impaired circulation and flushed sensations to the extremities (causing discoloration). The involved upper extremity can feel weak. Often symptoms are reproduced or worsened 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.

What tests do physicians use to diagnose thoracic outlet syndrome?

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The diagnosis of thoracic outlet syndrome is suggested by the symptoms and supported by findings of the doctor during the examination. Certain maneuvers of the arm and neck can produce symptoms and blood vessel "pinching," causing a loss of pulse. This includes the Adson's maneuver, whereby the examiner moves the shoulder joint into positions that can cause pinching of both the nerves and artery to the tested arm. Further supportive testing can include electrical tests, such as electromyogram (EMG) and somatosensory evoked responses (although these may not be positive in all patients). Some patients can have angiogram X-ray tests that demonstrate the pinched area of the blood vessel involved.

Medically Reviewed by a Doctor on 3/26/2015

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