Thoracic outlet syndrome

• Illustrations
• Definition
• Causes, incidence, and risk factors
• Symptoms
• Signs and tests

• Treatment
• Expectations (prognosis)
• Complications
• Calling your health care provider

Definition    Return to top

Thoracic outlet syndrome is a condition characterized by pain in the neck and shoulder, numbness/tingling of the fingers, and weakening of the grip.

Causes, incidence, and risk factors    Return to top

Thoracic outlet syndrome is a rare condition caused by compression of blood vessels and nerves in the area of the clavicle (collar bone). This compression usually is caused by the presence of an extra cervical rib (above the first rib) or an abnormal tight fibrous band connecting the spinal vertebra to the rib.

People with long necks and droopy shoulders may be predisposed to develop this condition because of extra pressure on their nerves and blood vessels.

Symptoms    Return to top

The following symptoms may indicate thoracic outlet syndrome:

• Discomfort in the last 3 fingers (middle, ring, and pinky) and inner forearm
  • Numbness
  • Pain
  • Tingling
• Pain and tingling in the neck and shoulders (may be worsened by carrying something heavy, such as a suitcase)
• Weakness and wasting of the muscles of the hand

Signs and tests    Return to top

Upon lifting, the arm may appear pale due to compression of the blood vessels. The arm may be smaller on the side of the symptoms, as this is often a congenital anomaly (present since birth).

Tests to confirm the diagnosis include the following:

• X-ray (may reveal an extra rib)
• MRI (may reveal fibrous band)
• Nerve conduction velocity study
• Electromyography (EMG)

Treatment    Return to top

The syndrome is generally treated conservatively, with physical therapy to strengthen the shoulder muscles, improve range of motion, and promote better posture, as well as with analgesics or other pain medications.

Surgery is used as a last resort, but can be effective in select cases. Your doctor may suggest other alternatives.

Expectations (prognosis)    Return to top

If selected carefully, patients undergoing removal of the fibrous band may have resolution of their symptoms. Conservative approaches using physical therapy are helpful in many patients.

Complications    Return to top

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

Calling your health care provider    Return to top

Call your health care provider if you experience any of the symptoms of thoracic outlet syndrome.