About Thoracic Outlet Syndrome

General Information

• Thoracic outlet syndrome involves compression of the brachial plexus, subclavian artery and subclavian vein by a cervical rib, fibrous band or other nearby structures.
• The brachial plexus nerve network manages the sensory and motor functions of the shoulders, arms, forearms and hands, and some muscles of the back and chest. The subclavian blood vessels rest beneath the clavicle, or collar bone.

Symptoms

• Symptoms include neck and shoulder pain with numbness, tingling, and "pins and needles" sensation in the forearm that worsens when carrying a suitcase, shopping bag or similar item.
• Decrease in size of the muscles and weakness of the hands may also occur.
• Signs of compression of the subclavian artery and vein include whiteness from decreased blood flow when elevating an affected arm; Raynaud’s phenomenon, or numbness or pain in the feet or hands; brittle nails; and loss of wrist pulse upon outward movement of the shoulder.

Diagnosis

• Plain x-rays of the brachial plexus region may reveal the source of the compression.
• Nerve conduction studies and electromyography (EMG) will help distinguish thoracic outlet syndrome from other peripheral nerve lesions.

Treatment

• In middle-aged people with poor posture and no evidence of abnormality on plain x-rays, neck and postural exercises may be helpful.
• In some patients, surgical section of the fibrous band and/or removal of the cervical rib can relieve sensory symptoms and may halt the progression of motor abnormalities.