Thoracic outlet syndrome
Thoracic outlet syndrome is a rare condition that involves:
The thoracic outlet is the area between the ribcage and collarbone.
Nerves coming from the spine and major blood vessels of the body pass through a narrow space near your shoulder and collarbone on the way to the arms. Sometimes, there is not enough space for the nerves to pass by through the collarbone and upper ribs.
Pressure (compression) on these blood vessels or nerves can cause symptoms in the arms or hands.
Pressure may happen if you have:
People with this syndrome often have injured the area in the past or overused the shoulder.
People with long necks and droopy shoulders may be more likely to develop this condition because of extra pressure on the nerves and blood vessels.
Symptoms of thoracic outlet syndrome may include:
Exams and Tests
Your health care provider will examine you and ask about your medical history and symptoms.
The following tests may be done to confirm the diagnosis:
Tests are also done to rule out other problems, such as carpal tunnel syndrome or a damaged nerve due to problems in the neck.
Physical therapy is often used to treat thoracic outlet syndrome. It helps:
Your provider may prescribe pain medicine.
If there is pressure on a vein, your provider may give you a blood thinner to prevent a blood clot.
You may need surgery if physical therapy and changes in activity do not improve your symptoms. The surgeon may make a cut either under your armpit or just above your collarbone.
During surgery, the following may be done:
Your doctor may also suggest other alternatives, including angioplasty, if the artery is narrowed.
Surgery to remove the extra rib and break up tight fiber bands may ease symptoms in some people. Some people have symptoms that return after surgery.
Complications can occur with any surgery, and depend on the type of procedure and anesthesia.
Risks related to this surgery include:
Filler AG. Brachial plexus nerve entrapments and thoracic outlet syndromes. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 250.
Osgood MJ, Lum YW. Thoracic outlet syndrome: pathophysiology and diagnostic evaluation. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 120.
Review Date: 10/23/2018
Reviewed By: Mary C. Mancini, MD, PhD, Director, Cardiothoracic Surgery, Christus Highland Medical Center, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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