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This article may contain information on medical procedures that are not recommended or endorsed by Catholic Health Partners. Promotion of this topic is prohibited by the Ethical and Religious Directives for Catholic Health Services. In the Ethical and Religious Directives, Catholic health institutions are prohibited from condoning contraceptive practices. Married couples should be given information about natural family planning as well as the church’s teachings on responsible parenthood. The information in this article is designed for educational purposes only. It is not provided as a professional service or as medical advice for specific patients.

Thoracic outlet syndrome

Definition

Thoracic outlet syndrome is a rare condition that involves pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip. The thoracic outlet is the area between the rib cage and collar bone.

Alternative Names

Causes, incidence, and risk factors

Blood vessels and nerves coming from the spine or major blood vessels of the body pass through a narrow space near the shoulder and collarbone on their way to the arms. As they pass by or through the collarbone (clavicle) and upper ribs, they may not have enough space.

Pressure (compression) on these blood vessels or nerves can cause symptoms in the arms or hands. Problems with the nerves cause almost all cases of thoracic outlet syndrome.

Compression can be caused by an extra cervical rib (above the first rib) or an abnormal tight band connecting the spinal vertebra to the rib. Patients 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

Symptoms of thoracic outlet syndrome may include:

  • Pain, numbness, and tingling in the pinky and ring fingers, and the inner forearm
  • Pain and tingling in the neck and shoulders (carrying something heavy may make the pain worse)
  • Signs of poor circulation in the hand or forearm (a bluish color, cold hands, or a swollen arm)
  • Weakness of the muscles in the hand

Signs and tests

When you lift something, the arm may look pale due to pressure on the blood vessels.

The diagnosis is typically made after the doctor takes a careful history and performs a physical examination. Sometimes the following tests are done to confirm the diagnosis:

Tests are also done to make sure that there are no other problems, such as carpal tunnel syndrome or a damaged nerve due to problems in the cervical (neck) spine.

Treatment

When thoracic outlet syndrome affects the nerves, the first treatment is always physical therapy. Physical therapy helps strengthen the shoulder muscles, improve range of motion, and promote better posture. Treatment may also include pain medication.

If there is pressure on the vein, your doctor may give you a blood thinner to dissolve the blood clot. This will help reduce swelling in your arm.

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:

  • An extra rib is removed and certain muscles are cut.
  • A section of the first rib is removed to release pressure in the area.
  • Bypass surgery is done to reroute blood around the compression or remove the area that is causing the symptoms.

Your doctor may also suggest other alternatives, including angioplasty if the artery is narrowed.

Support Groups

Expectations (prognosis)

Having the first rib removed and the fibrous bands broken may relieve symptoms in certain patients. Surgery can be successful in 50% to 80% of patients. Conservative approaches using physical therapy are helpful for many patients.

At least 5% of patients have symptoms that return after surgery.

Complications

Complications can occur with any surgery and relate to the type of procedure and anesthesia used.

Damage to nerves or blood vessels may occur during surgery. This could lead to weakness of the arm muscles, or weakness of the muscles that help control the diaphragm when you breathe.

Calling your health care provider

Prevention

References

Smythe WR, Reznik SI, Putnam Jr. JB. Lung (including pulmonary embolism and thoracic outlet syndrome). In: Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 59.

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    Review Date: 11/1/2010

    Review By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

    The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2010 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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