Thoracic Outlet Syndrome

Thoracic outlet syndrome is a condition brought about by abnormal compression of a collection of nerves, arteries and veins by bony, ligamentous or muscular obstacles between the cervical spine and the lower border of the axilla (armpit). The nerves involved are referred to the neurovascular bundle. This bundle includes structures called the brachial plexus (motor and sensory nerves of the arm, hand and shoulder blade), C8 and T1 nerve roots and the subclavian artery and vein (which transport blood to and from the arm).

Symptoms of TOS can be:

Neurological in nature:

• Parasthesia along the inside forearm and the palm
• Muscle weakness and atrophy of the gripping muscles and small muscles of the hand
• Difficulty with fine motor tasks of the hand
• Cramps of the muscles on the inner forearm
• Pain in the arm and hand
• Tingling and numbness in the neck, shoulder region, arm and hand

Or vascular in nature:

• Swelling or puffiess in the arm or hand
• Bluish discoloration of the hand
• Feeling of heaviness in the arm or hand
• Pulsating lump above the clavicle
• Deep, boring toothache-like pain in the neck and shoulder region

Causes of Neurovascular Compression include:

• Anterior scalene tightness
• Compression in the space between the clavicle, the first rib and the muscular and ligamentous structures in the area-probably from postural deficiencies or carrying heavy objects.
• Pectoralis minor tightness

Treatment of TOS includes stretching of the back, neck, chest and shoulder and mobilization of the first rib. In addition, physiotherapy modalities and postural correction can be very helpful.