Thoracic Outlet Syndrome

This a condition that results in pain in the neck and shoulder as well as numbness, tingling, and weakness of the hand. The thoracic outlet is the area between the collarbone and rib cage.

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Causes

Blood vessels and nerves arising from the spine pass through a narrow space near the shoulder and collarbone as they travel to the arms. Major blood vessels from the body pass through this space.

Compression of these blood vessels or nerves can cause symptoms in the arms or hands. Thoracic outlet syndrome is usually caused by compression of the nerves.

Causes of the compression include an extra cervical rib (above the first rib) or an abnormal tight band connecting the spinal vertebra to the rib. Overuse of the involved shoulder and previous injuries to this area are common.

Symptoms/Signs

  • pain, numbness, and tingling in the pinky and ring fingers;
  • pain, numbness, and tingling in the neck, shoulders and inner forearms;
  • discoloration, coldness, or swelling in the forearm and/or hand; and
  • hand weakness.

Tests

  • x-ray,
  • CT angiogram,
  • MRI,
  • nerve conduction velocity study, and
  • electromyography (EMG).

Treatment

Physical therapy to strengthen the neck/shoulder muscles, improve range of motion, and improve posture is recommended.

If a blood clot develops in a vein, a blood thinner to dissolve the blood clot will assist in reducing the swelling in one’s arm.

Surgery, which is the last resort, may involve removing an extra rib or cutting certain muscles to relieve pressure. Bypass surgery is another possibility.

Angioplasty of the artery can widen the area which is narrowed.

A cervical (neck) spine MRI should be performed, before surgery, to rule out the neck as the cause of the symptoms because many symptoms of cervical radiculopathy overlap with those of thoracic outlet syndrome.

Jose Veliz MD is the medical director of Palomar Spine & Pain, in Escondido, CA (North San Diego County).

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