Thoracic Outlet Syndrome

Thoracic outlet syndrome is a condition that occurs when blood vessels and/or nerves between the collarbone and top rib bone become compressed. This compression or pressure generally causes arm pain, neck pain and/or finger numbness on the affected side. Thoracic outlet syndrome may be diagnosed as one of two main different types of disorders known as neurogenic and vascular. The two different disorder types are diagnosed based on the specific causes of a patient’s thoracic outlet syndrome.

Drawing of Thoracic Outlet Nerves

The neurogenic variation of thoracic outlet syndrome occurs when a network of nerves known as the brachial plexus become compressed. The brachial plexus stems out from the spinal cord and runs through the neck, armpit region and upper arm. Most cases of thoracic outlet syndrome are diagnosed as being neurogenic. This variation of thoracic outlet syndrome can cause weakened grip, tingling in the fingers and aching neck pain and arm pain.

Vascular thoracic outlet syndrome is attributed to the compression of veins or arteries under the collarbone. This variation of thoracic outlet syndrome is also sometimes labeled as venous if veins are compressed or arterial if arteries are compressed. Whereas neurogenic thoracic outlet syndrome causes the shoulder and arm to ache, the vascular variation of the disorder generally causes more of a weakness in the arm and neck. Other vascular thoracic outlet syndrome symptoms include hand or arm discoloration, cold fingers, arm swelling and weak pulse in the arm of the injured side.

Thoracic Outlet Syndrome

Thoracic outlet syndrome often occurs due to trauma from events such as car accidents or due to repeated strain to the brachial plexus area from activities such as throwing. Repetitive strain as a cause for thoracic outlet syndrome is evident in several cases among Major League Baseball pitchers such as Chris Carpenter, Matt Harrison and Josh Beckett. Other causes of thoracic outlet syndrome include congenital disorders or tumors that lead to compression in the brachial plexus. The most common congenital disorder that causes thoracic outlet syndrome is a cervical rib. Meanwhile, certain types of lung cancer may produce a tumor at the top of the lung that presses on nerves to cause thoracic outlet syndrome.

Treatment for thoracic outlet syndrome varies based on severity and type. However, many patients respond positively to physical therapy, stretching and chiropractic therapy. Additionally, cortisone injections are often used for thoracic outlet syndrome due to their ability to reduce inflammation. Botox may also be used for neurogenic thoracic outlet syndrome on some occasions to bind nerve endings to stop pain.

In severe cases or in cases where standard treatments fail to provide relief, patients may undergo surgery to treat thoracic outlet syndrome. Surgical procedures may involve the removal of a rib should that be determined to be a major source of nerve or arterial compression. In addition, fibrous tissues around the brachial plexus may be removed to relieve pressure in th area.