What is Thoracic Outlet Syndrome / TOS Shoulder?

Thoracic Outlet Syndrome (TOS) refers to a number of disorders that can occur as a result of compression of a bundle of nerves and blood vessels that exit the chest area to supply innervation and circulation to the arms. The bundle of nerves that is affected in Thoracic Outlet Syndrome is called the brachial plexus. This bundle is located specifically in the opening between the collarbone and first rib. This space is referred to as the thoracic outlet. Thoracic outlet syndrome is commonly overlooked and misdiagnosed as the symptoms can be similar to many other conditions. Thoracic outlet syndrome can be either neurogenic or vascular, depending on if the nerves or blood supply is more compromised. Nerve involvement is a much more frequent finding in this disorder, however.

What Causes Thoracic Outlet Syndrome?

There are many causes that can lead the thoracic outlet passageway to cause compression of these structures. Some causes may be:

● Congenital bony abnormalities relating to the thoracic outlet, most commonly seen as an individual who was born with an extra rib
● Trauma such as from a car or motorcycle accident
● Tumors in the chest
● A sports-related injury to the chest
● Pregnancy which can cause ligaments to become lax and move positioning of bones
● Obesity
● Sleep disorders
● Weight lifting
● Repetitive motion of the arms from sports participation or job duties
● Poor posture (slouching)

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What are Symptoms of TOS Shoulder?

Symptoms of TOS can be quite similar to other conditions, making it difficult to accurately diagnose. Symptoms of Thoracic Outlet Syndrome that you may experience are:

● Chest pain, which is often confused with a cardiac condition
● A sensation of throbbing near your clavicle (collarbone)
● Tingling, numbness, or weakness that can extend to the arm, hands, or fingers as a result of nerve compression
● Discoloration of your chest or arm from a lack of blood supply
● Muscle wasting in the thumb on the side of the affected shoulder
● Swelling
● Lack of pulse
● Cold hands and fingers

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What Can Be Done for Thoracic Outlet Syndrome?

The most common form of treatment for Thoracic Outlet Syndrome is a course of physical therapy, particularly in the case of nerve involvement as in neurogenic TOS. Physical therapy will consist of specific exercises to target muscles affecting the thoracic outlet with the hope that in time as the muscles grow stronger, they will cause less pressure to be places on the nerves and blood vessels that exit through the thoracic outlet. Stretching exercises as well as posture education to help increase the space in the thoracic outlet will also be prescribed.

Medications such as NSAIDs (non-steroidal anti-inflammatory drugs) and muscle relaxers may be considered.

In a small number of cases, if conservative measures have not worked to decrease pain and other symptoms, surgery may be indicated in order to increase the space in the passageway of the thoracic outlet. This surgery is called Thoracic Outlet Decompression and consists of a few different approaches that your surgeon may choose. These approaches are removal of the first rib or a removal of muscles with repair to any damaged blood vessels.
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