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Anatomy of the Thoracic Outlet

The thoracic outlet is a small passageway leading from the base of the neck to the armpit and arm. This small area contains many blood vessels, nerves, and muscle.

What is a Thoracic Outlet Syndrome?

When this passageway becomes compressed, the condition is termed as thoracic outlet syndrome. It generally occurs within the age group of 20 to 60 years and is more common in females than in males.

Types of Thoracic Outlet Syndrome

There are 3 types of thoracic outlet syndrome:

  • Neurogenic thoracic outlet syndrome
  • Arterial thoracic outlet syndrome
  • Venous thoracic outlet syndrome

Causes of Thoracic Outlet Syndrome

Thoracic outlet syndrome can result due to injury, tumors that press nerves, poor posture that compresses nerves, weight lifting, anatomical defects such as an elongated C7 transverse process, anomalous tissue overgrowth, upper thoracic neurovascular compression, costocoracoid tendon, and subclavian muscle hypertrophy to name a few.

Symptoms of Thoracic Outlet Syndrome

The symptoms of thoracic outlet syndrome may include numbness and pain in the neck, shoulder, and arm, tingling or burning sensation, weakness, limited range of movement of arms, and swelling or redness of your arm, color changes to the arm or hand, and a weak hand grip.

Diagnosis of Thoracic Outlet Syndrome

To evaluate your condition, your doctor will perform a physical examination and collect your medical history. You may be advised to have a chest X-ray, MRI or CT scan. Your doctor may also recommend blood tests and electromyogram evaluation. Nerve conduction velocity study may be suggested to check the conduction of electrical signals in the nerves.

Treatment Options for Thoracic Outlet Syndrome

The treatment of thoracic outlet syndrome involves both non-surgical and surgical approach.

Non-surgical Treatments for Thoracic Outlet Syndrome

The non-surgical treatments may include:

  • Physical therapy: Exercises can decrease the pressure on the nerves and blood vessels and strengthen the muscles surrounding the shoulder. Maintaining proper posture can help you stand, sit and walk straight.
  • Non-steroidal anti-inflammatory medications: NSAIDs can reduce pain and swelling
  • Weight loss: You are advised to reduce your weight if you are considered overweight.
  • Lifestyle changes: You are advised to avoid strenuous activities and other activities that increase the risks or symptoms.

Surgical Treatment for Thoracic Outlet Syndrome

If non-surgical treatment does not alleviate your symptoms, your doctor may advise surgery. Surgery may involve removing a portion of an abnormal first rib or releasing a muscle that joins the neck and chest. The surgery will depend on the cause of the compression.

  • American Osteopathic Association
  • American Osteopathic Academy of Orthopedics
  • American Medical Association
  • American Academy of Orthopaedic Surgeons
  • North American Spine Society