Written by Rebecca Budde, SIU School of Medicine
Just behind and below the collarbone is a tiny space that causes massive pain for many people. The thoracic outlet houses the many blood vessels, muscles and nerves that serve the entire arm. But because the space is so compact, pressure against the nerves or blood vessels in this area can cause debilitating symptoms known as thoracic outlet syndrome (TOS).
Repetitive stress injuries (RSI) and accidents tend to be the main cause of TOS, but habitual sleeping or working positions can also lead to TOS over time. “A painter, linesman, hairdresser, pro athlete or someone who continually reaches overhead and does the same repetitive motion every day is more likely to develop TOS,” Dr. Sapan Desai says.
“If you’re involved in an accident and your muscles swell to double their size, there’s no room for anything to get through,” Dr. Desai explains. “The veins and arteries can stop working, resulting in swelling in the arm and hand. The veins can clot, and you could actually lose your arm or the clots can travel to the lung and heart and create life-threatening pulmonary embolisms.”
There are three types of TOS:
1. Neurogenic, the most common type, can cause pain, numbness, neck pain, headaches in the back of the head, tingling and/or weakness in the affected arm and hand.
2. Venous causes swelling of the entire arm as well as pain and dark discoloration.
3. Arterial, the rarest but probably the most serious of the three, causes pain, coldness, paleness and cramps in the hand.
Dr. Desai, a vascular surgeon at SIU School of Medicine explains that the symptoms are often confused with other conditions and lead to unnecessary surgeries and expensive therapies. Dr. Desai is one of the only physicians in Springfield who routinely performs thoracic outlet decompression surgery, which is the only known cure for patients who suffer from TOS. Hear Dr. Desai explain thoracic outlet decompression surgery in this video.
In some cases, physical therapy can somewhat improve the symptoms of neurogenic TOS. Dr. Desai says that he requires patients with this type of TOS try physical therapy before considering an operation. By stretching the muscles in the neck, correcting posture and avoiding certain movements that may aggravate the symptoms, a few patients may find some relief. However, for most patients, the symptoms will continue or worsen, making TOS decompression surgery the best option for a cure.
Read more about Dr. Desai and thoracic outlet decompression surgery in SIU’s Aspects magazine.
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