Thoracic outlet syndrome

Definition

Thoracic outlet syndrome is a combination of 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.

Causes

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

Symptoms of thoracic outlet syndrome may include:

• Pain, numbness, and tingling in the last three fingers and inner forearm
• Pain and tingling in the neck and shoulders (carrying something heavy may make the pain worse)
• Weakness of the muscles in the hand

Exams and Tests

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

Physical therapy helps strengthen the shoulder muscles, improve range of motion, and promote better posture. Treatment may also include pain medication.

Surgery is used as a last step. Your doctor may use bypass surgery to reroute blood around the compression or remove the structure that is causing the symptoms. Your doctor may also suggest other alternatives, including angioplasty.

Outlook (Prognosis)

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.

Possible Complications

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