Thoracic Outlet Syndrome

What is a thoracic outlet syndrome?

The thoracic outlet is a passage between your neck and armpit that contains blood vessels and nerves. In thoracic outlet syndrome there is a compression of the nerves, blood vessels or both.

How does it occur?

Thoracic outlet syndrome occurs when the size and shape of the outlet is compressed and narrowed. This can happen because of posture, muscle tightness, exercise, trauma, pregnancy, or being born with an extra rib (a cervical rib which is above the first rib).

Certain activities or postures can lead to thoracic outlet syndrome. People who stand for long periods of time (like cashiers or assembly line workers) may droop their shoulders and lean their head forward. People who carry heavy loads on their shoulders can develop a compression in the outlet. Athletes or those in occupations with repetitive overhead arm movements may also develop thoracic outlet syndrome.

What are the symptoms?

Symptoms can be caused by the compression of nerves, blood vessels or both. They can include:

• Tingling or numbness in the fingers, hands, arm, shoulder or neck.
• Weakness of the hand or arm.
• Hand or arm swelling.
• Aching in the shoulder or neck.

Symptoms may be worse when the arm is lifted above shoulder height.

How is it diagnosed?

Your provider will listen to your history and will examine your neck, shoulder, arm and hand. There may be swelling, weakness or numbness in your hand or arm. You may have tightness in your neck. You may have a loss or decrease of the pulse at your wrist. Your provider may order X-rays to see if you have a cervical rib or to make sure there are no problems in your neck. They may order special nerve tests.

How is it treated?

Treatment is aimed at reducing the compression in the thoracic outlet. This can include:

• Exercises to improve your posture that will allow you to stand and sit straighter.
• Exercises to help stretch tight tissue around the thoracic outlet.
• Exercises to strengthen and stabilize the muscles in the shoulder and neck.
• Changing your workstation to have better posture.
• Avoiding sleeping with your arm in an overhead position.
• Losing weight (if you are overweight).
• Taking anti-inflammatory medicine recommended or prescribed by your provider as needed. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
• In rare cases surgery is done to relieve the symptoms of thoracic outlet syndrome.

When can I return to my sport or activity?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers at a different rate. Return to your sport or activity depends on how soon your symptoms improve, not by how many days or weeks it has been since you started having symptoms. In general, the longer you have symptoms before treatment, the longer it will take to get better.

It is important that your sport or activity does not worsen your symptoms. You may need to reduce repetitive activities or change your posture or technique.

If you have had surgery your provider will give you specific instructions about return to activity.

How can I prevent thoracic outlet syndrome?

The best way to prevent thoracic outlet syndrome is to:

• avoid repetitive overhead activities
• make sure your posture is good
• not carry heavy loads on your shoulders