- Home Remedies
What is thoracic outlet syndrome (TOS)?
Thoracic outlet syndrome (TOS) is a condition whereby symptoms are produced (such as numbness in fingers, and pain in the shoulder, arm, and neck) due to compression of nerves and/or blood vessels in the upper chest. The passageway for these nerves and blood vessels to exit the chest and supply the upper extremities is referred to as the thoracic outlet. Muscle, bone, and other tissues border the thoracic outlet. Any condition that results in enlargement or movement of these tissues of or near the thoracic outlet can cause thoracic outlet syndrome. These conditions include muscle enlargement (such as from weight lifting), injuries, an extra rib extending from the neck (cervical rib), weight gain, and rare tumors at the top of the lung. Often no specific cause is detectable.
Some scientists feel 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 a flattening of the chest cage and a shift of the shoulder joint backward, both of which narrowed the thoracic outlet.
What causes thoracic outlet syndrome?
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.
Risk factors include occupations that involve heavy usage of the upper extremities against resistance, including jackhammer 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, including poor posture.
What are the symptoms of thoracic outlet syndrome?
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.
Diagnosis of thoracic outlet syndrome
Doctors who treat thoracic outlet syndrome include general physicians, such as general-medicine doctors, family medicine doctors, and internists, as well as rheumatologists, physical-medicine doctors, and chest surgeons.
The diagnosis of thoracic outlet syndrome is suggested by the symptoms and supported by the 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 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.
What is the treatment for thoracic outlet syndrome?
Treatment of thoracic outlet syndrome can usually be successful with conservative measures. Treatments include a variety of exercises that effectively stretch open the tissues of the thoracic outlet. These are done with and without weights in the hands to pull the outlet into a "relaxed" open position. Physical therapists are specially trained in the instruction of exercises for thoracic outlet syndrome, and their evaluation of the patient can be helpful. Shoulder-shrug exercises and others can be done at home or at work to relax the muscles around the thoracic outlet.
Some patients with severe, resistant symptoms can require surgery to open the thoracic outlet. These procedures include interruption of the scalene muscle (scalenotomy) and removal (resection) of the first rib to spare injury to the affected nerve and blood vessels from ongoing compression. Thoracic outlet syndrome that affects the vascular system (veins and arteries) is more likely to require surgery to resolve the symptoms.
What are home remedies for thoracic outlet syndrome?
Patients should avoid prolonged positions with their arms held out or overhead. For example, it is best to avoid sleeping with the arm extended up behind the head. It is also helpful to have rest periods at work to minimize fatigue. Weight reduction can be helpful for obese patients. Patients should avoid sleeping on their stomachs with their arms above their heads. They should also not repetitively lift heavy objects.
What is the prognosis for thoracic outlet syndrome?
Most people with thoracic outlet syndrome can have complete resolution of symptoms with conservative measures, including exercises specific for thoracic outlet syndrome, physical therapy, and avoiding stressing the tissues of the thoracic outlet. It can be helpful to avoid sleeping with the arms extended above the head. Rarely, surgical intervention can be necessary to take pressure off of involved nerves and blood vessels.
Complications include embolization to the hand and nerve damage to the extremity involved.
Is it possible to prevent thoracic outlet syndrome?
It's possible to prevent thoracic outlet syndrome by maintaining relaxed tissues of the upper chest. This can involve prevention exercises, stretches, and therapies designed to loosen the tissues around the shoulders and neck.
Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology. Philadelphia: W.B. Saunders Co., 2000.
Top Thoracic Outlet Syndrome Related Articles
Chest X-RayChest X-Ray is a type of X-Ray commonly used to detect abnormalities in the lungs. A chest X-ray can also detect some abnormalities in the heart, aorta, and the bones of the thoracic area. A chest X-ray can be used to define abnormalities of the lungs such as excessive fluid (fluid overload or pulmonary edema), fluid around the lung (pleural effusion), pneumonia, bronchitis, asthma, cysts, and cancers.
Childhood ObesityFast-food consumption and lack of exercise are just a couple of causes of childhood obesity. Health effects of childhood obesity include type 2 diabetes, heart attack, stroke, high cholesterol, asthma, sleep apnea, gallstones, fatty liver disease, GERD, depression, and eating disorders.
Chronic Pain Syndrome: Treatment and Management for CPSDo you suffer from excruciating pain? What is chronic pain syndrome (CPS)? See causes, symptoms and treatment options, including medications. Learn about pain management tips such as strength training, biofeedback, and yoga, as well as forms of chronic pain such as lower back pain, arthritis, and migraines.
Electromyogram (EMG)Electromyogram or EMG is defined as a test that records the electrical activity of muscles. Normal muscles produce a typical pattern of electrical current that is usually proportional to the level of muscle activity. Diseases of muscle and/or nerves can produce abnormal electromyogram patterns.
Fatigue and Exhaustion
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases, for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, and drug abuse.Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
How Is A Sternotomy Done?A sternotomy is a surgical incision made through the breastbone (sternum) to access the thoracic cavity. A median sternotomy is the primary approach used for major surgeries in the thoracic region, as it offers a wide view.
ibuprofenIbuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce mild to moderate pain, inflammation, and fever. Ibuprofen works by blocking an enzyme that makes prostaglandin (a hormone-like substance that participates in a variety of body functions), which results in lower levels of prostaglandins in the body. Lower levels of prostaglandins reduce pain, inflammation, and fever. Ibuprofen is prescribed to treat diseases and conditions that cause mild to moderate pain, fever, and inflammation.
MRI (Magnetic Resonance Imaging Scan)MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Obesity and OverweightGet the facts on obesity and being overweight, including the health risks, causes, reviews of weight-loss diet plans, BMI chart, symptoms, causes, surgical and nonsurgical treatments, and medications.
Raynaud's PhenomenonRaynaud's phenomenon is characterized by a pale-blue-red sequence of color changes of the digits, most commonly after exposure to cold. Occurring as a result of spasms of blood vessels, the cause is unknown. Symptoms and signs of Raynaud's phenomenon depend on the severity, frequency, and duration of the blood vessel spasm. Treatments include protection of the digits, medications, and avoiding emotional stresses, smoking, cold temperature, and tools that vibrate the hands.
Sleep DisordersA number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. The National Institutes of Health recommend about 7-9 hours of sleep each night for older, school-aged children, teens, and most average adults; 10-12 for preschool-aged children; and 16-18 hours for newborns. There are two stages of sleep: 1) REM sleep (rapid-eye movement), and 2) NREM sleep (non-rapid-eye movement).
What Is Thoracic Endovascular Aortic Repair (TEVAR)?Thoracic endovascular aortic repair (TEVAR) is a procedure to repair the major blood vessel in the body called the aorta. It is a minimally invasive procedure in which a small incision is made for repairing the aorta. Complications include bleeding, endoleak (leaking of blood around the graft), displacement of the graft away from its initial placement, stent fracturing, infections, delayed rupture of the aneurysm, stroke, paralysis, and blood vessel injury.