Thoracic Outlet Syndrome

Thoracic outlet syndrome is a group of disorders that occur due to the compression, injury or irritation of the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest area. This condition is named for the space (the thoracic outlet) between your neck and upper chest where this grouping of nerves and blood vessels is found.

In this condition, the brachial plexus and/or subclavian/ axillary arteries are compressed at various sites as they travel down into the arm. Cervical rib (C7), scalene muscle, costoclavicular area and sub- coracoid area (between coracoid and pec minor) are all possible sites of compression. This condition is common in athletes with repetitive overhead activities or shoulder activities. Post clavicle fracture deformity, AC joint degeneration, postural alterations, Playing a musical instrument, Post rib fracture and Congenital anomaly in region.

There are three types of Thoracic outlet syndrome: Arterial, venous compromise and neurogenic compromise. 90-95% of cases of TOS are due to venous compromise.

Neurogenic thoracic outlet syndrome

This condition is due to the abnormalities of bony and soft tissue in the lower beck region that compress and irritate the nerves of the brachial plexus, the complex of nerves that supply motor  and sensory function to the arm and hand.  The symptoms of neurogenic thoracic outlet syndrome may include weakness of the hand, decreased size of hand muscles, tingling, prickling, numbness, and weakness of the neck, chest, and arms.

Venous thoracic outlet syndrome

This condition occurs due to the damage to the major veins in the lower neck and upper chest. It can develop suddenly and/or often after unusual and excessive exercise of the arms.  The symptoms may include swelling of the hands, fingers, and arms. As well as heaviness and weakness of the neck and arms. The veins in the anterior (front) chest wall veins also may appear inflamed (swollen).

Arterial thoracic outlet syndrome

This is the least common type of Thoracic outlet syndrome, but the most serious. It is caused by congenital (present at birth) bony abnormalities in the lower neck and upper chest. The symptoms may include cold sensitivity in the hands and fingers; numbness, pain or sores of the fingers; and poor blood circulation to the arms, hands and fingers.

The cause of this disorder is unknown. When the blood vessels and nerves in the tight passageway of the thoracic outlet are abnormally compressed, they become irritated. It can also be a result of an extra first rib, an old fracture of the clavicle that reduces the space for the vessels and nerves. Bony and soft tissue abnormalities are among the many other causes.

Causes and Risk

The following may increase the risk of developing thoracic outlet syndrome due to sleep disorders, Tumours or large lymph nodes in the upper chest or underarm area.

Stress or depression. Sports that involves repetitive arm or shoulder movements, such as baseball, swimming, volleyball, and others.

Repetitive injuries from carrying heavy shoulder loads, Injury to the neck or back (whiplash injury), Poor posture and Weightlifting.

Thoracic outlet syndrome is diagnosed by performing a complete physical exam and reviewing the results of diagnostic tests.  A thorough evaluation by neurologist may also be recommended to rule out any cervical spine disease or other neurological conditions that may cause those symptoms. Physical examination may include thorough postural assessment, orthopaedic tests e.g. Adson, modified Adson, wrights test, Eden, east test to rule out the type of TOS present.

Additional tests may include Nerve conduction studies, Vascular studies, Chest X-rays to rule out cervical rib abnormalities, Cervical spine X-rays to rule out a cervical rib or cervical spine abnormalities, Computed tomography scan and magnetic resonance imaging of the chest, spine to rule out cervical spine impingement, which can mimic neurogenic thoracic outlet syndrome, Magnetic resonance imaging with angiography to view blood vessels, Arteriogram/venogram and Blood tests.

Complications of Thoracic outlet syndrome may include Permanent arm swelling and pain. Ischemic ulcer of the fingers, Gangrene, Blood clot. Pulmonary embolism and Neurogenic complications such as permanent nerve damage.

Treatment

Treatment of thoracic outlet syndrome may include physical therapy, chiropractic care, medications, surgery. The role of physical therapy and Chiropractic care is to increases the range of motion of the neck and shoulders to strengthens muscle and promote better posture. Most patients experience an improvement in symptoms after undergoing physical therapy.  Medication may include aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin).

If nonsurgical treatment wont relieve symptoms, doctor may offer surgery which involve removing a portion of an abnormal first rib, releasing a muscle that joins the neck and chest, or sometimes both.

For chiropractic care, we will begin with your health history following up with orthopaedics, neurological testing and spinal exam.

These tests will help to create a baseline of your spinal function and to any neurological and musculoskeletal condition. Your Chiropractor will focus to find, analyze and correct the joint misalignments in your spine. It will help to strengthen the weakened muscles focusing more towards your cervical and thoracic spine.

This process will ultimately stabilize your spine and correct any joint dysfunction present.

If  you know anyone experiencing symptoms of thoracic outlet syndrome, contact your Chiropractor and start your journey towards healthy living.