Thoracic outlet syndrome is a condition caused by compression of the nerves and veins located at the chest outlet, above the ribs and behind the shoulder blade. While more common in adults, it is rare in children. Venous and arterial thoracic outlet syndrome, caused by compression and swelling of veins throughout the body, manifests with symptoms such as pain and tingling. It can cause numbness, pain, and paleness, especially when raising the arms. Sensory changes in the arms may also occur due to nerve compression. Thoracic outlet syndrome can be unilateral or bilateral.

This condition can occur for a variety of reasons, including car accidents, workplace accidents, sports activities, congenital abnormalities, and pregnancy. Thoracic outlet syndrome generally responds well to treatment, but in some cases, it may require surgical intervention. Thoracic outlet syndrome represents a group of conditions caused by compression of the nerves, arteries, and veins in the upper chest and lower neck. It is also called "thoracic outlet syndrome." The thoracic outlet refers to the opening between the neck and chest and refers to the thoracic outlet. This area must be wide enough to allow passage of many different connections and tissues.

However, due to congenital or acquired changes, the structure of this passage can become distorted and narrowed. This narrowing of the thoracic outlet causes the bones and muscles to compress the blood vessels and nerves in this area, causing compression. This compression results in various abnormal symptoms in the upper body and arms. Sensory, color, and appearance changes may occur in the neck, shoulders, arms, hands, and fingers. Because the symptoms are so wide-ranging, thoracic outlet syndrome can be difficult to diagnose and can sometimes be detected late.

Symptoms of thoracic outlet syndrome

Symptoms of Thoracic Outlet Syndrome typically affect the upper body (neck, chest, arm, shoulder, and hand), usually on one side. Typical symptoms include:

• Pain worsened by raising arms: A feeling of pain that usually increases with raising or using the arms.
• Hand numbness or tingling: Feelings of numbness, tingling, or tingling, especially in the area from the arm to the tip of the hand.
• Swelling or feeling of heaviness: An abnormal feeling of swelling or heaviness in the affected area.
• Changes in skin color: Pale or bluish skin color, especially in cases where blood circulation is affected.

The symptoms of Thoracic Outlet Syndrome can vary depending on the type of syndrome, as the compressed structures include nerves or blood vessels. Here are the symptoms depending on the specific type:

Neurogenic thoracic outlet syndrome:

• Numbness or tingling in the arms and fingers.
• Weakness in grip strength.
• Pain in the shoulder, arm, neck and hand.

Venous thoracic outlet syndrome:

• Pain and swelling in the arm.
• Paleness or abnormal discoloration of one or more fingers or the entire hand.
• Arm fatigue as a result of activity.
• Blood clot in the veins of the upper body.

Arterial thoracic outlet syndrome:

• Cold fingers, hands and arms.
• Weak pulse and absence of pulse in the arm.
• Paleness or abnormal discoloration of one or more fingers or the entire hand.
• Hand and arm pain.

These symptoms can provide important information for diagnosing and treating thoracic outlet syndrome. However, because the symptoms are nonspecific, evaluation by a healthcare professional is essential.

Thoracic outlet syndrome disease types

Thoracic Outlet Syndrome (TOS) is divided into three main types based on the parts affected, and each type is associated with specific symptoms. The three main types of Thoracic Outlet Syndrome are:

Neurogenic (Neurological) TOS:

• It occurs as a result of compression of nerves coming from the spinal cord.
• It affects the network of nerves that control muscle movements and sensations in the arms, shoulders, and hands.
• The “Gilliatt-Sumner hand” symptom manifests as severe weakening or wasting of the fleshy part of the thumb.

Venous TOS:

• It occurs due to compression of one or more veins under the collarbone.
• Blood clots form, which can cause symptoms such as a weak pulse, paleness, tingling, and numbness in the arm.

Arterial TOS:

• It is the least common type of TOS.
• Compression of the arteries under the collarbone may cause the arteries to swell.
• It can cause symptoms such as color change, stinging sensation, or numbness, and is also called an aneurysm.

It's also possible to have a mixture of all three types, with multiple segments of the thoracic outlet compressed. In this case, symptoms and outlook can vary depending on the type of TOS and the combination of structures affected. Exercise and physical therapy can often be effective in alleviating TOS symptoms. However, in cases of vascular and neurogenic TOS, surgery may be necessary. The treatment plan should be personalized based on the patient's specific condition and symptoms.

Causes of thoracic outlet syndrome

The causes of Thoracic Outlet Syndrome can be diverse and the main factors can be classified as follows:

• Anatomical issues: Congenital anatomical variations can cause compression of nerves and blood vessels, particularly in the thoracic outlet area. This may include an extra rib near the first rib or a fused rib.
• Trauma: Sudden injuries affecting the upper chest and neck, such as car accidents, can put pressure on nerves in the thoracic outlet region, leading to internal changes. Symptoms associated with traumatic events often develop over time.
• Functional problems: Injury or irritation to the tissues in the thoracic outlet region due to repetitive movements is common, especially in people who participate in certain sports or strenuous work. Swimmers, baseball players, and heavy-duty athletes fall into this category.
• Postural problems: Slumped shoulders and a forward head position can put pressure on the thoracic outlet region. Poor posture can lead to the syndrome over time.
• Other factors: Pregnancy, obesity, tumors, sleep disorders, and depression can also contribute to thoracic outlet syndrome. These conditions can cause changes in the body and put pressure on nerves and blood vessels.
• Congenital problems: Congenital anatomical problems may contribute to an individual's predisposition to Thoracic Outlet Syndrome.

Thoracic Outlet Syndrome may be asymptomatic, or symptoms may develop over time. Treatment generally depends on the severity and cause of the symptoms. In addition to conservative measures such as exercise, physical therapy, and posture correction, surgery may also be necessary in some cases.

How is thoracic outlet syndrome diagnosed?

A number of tests and examinations are used to diagnose Thoracic Outlet Syndrome (TOS). The specialist who performs these diagnoses is usually a neurologist, orthopedist, or physical therapist. The methods used to diagnose TOS include:

Patient history and physical examination:

• The patient's history is taken and the symptoms are examined in detail.
• During the physical examination, the doctor will assess tenderness in the neck, shoulder, and arm area.
• Symptoms such as tingling, weakness, or numbness that occur when the hands are raised are examined.

Electromyography (EMG) and nerve conduction studies:

• An EMG test measures the electrical activity of muscles and helps identify nerve damage.
• Nerve conduction studies measure the speed of nerve conduction and can indicate nerve compression.

Chest X-ray:

• A chest X-ray can examine the structure of the spine, helping to identify spinal tumors or other structural problems.

Computed tomography (CT) and Magnetic resonance imaging (MRI):

• CT and MRI scans provide detailed images of the spine, spinal cord, and soft tissues. These tests can help identify tumors, disc disorders, and other structural problems.

Angiography (MRA) and venography:

• These tests can help identify blockages or narrowings by imaging blood vessels.

Blood tests:

• Blood tests can evaluate for signs of inflammation or another health problem.

Your doctor may recommend one or more of these tests, depending on the severity and type of your symptoms. Diagnosing TOS usually requires a combination of test results.

Thoracic outlet syndrome treatment methods

Treatment methods for Thoracic Outlet Syndrome (TOS) generally fall into two main categories: conservative and surgical. Here are the details of these treatment options:

Conservative treatment:

1. Physical therapy: Physical therapy aims to support the muscles in the affected area through muscle strengthening and posture correction exercises. Exercises performed under the guidance of a physical therapist aim to reduce nerve and vascular pressure.
2. Lifestyle changes: The aim is to reduce symptoms with lifestyle changes such as adjusting sleep patterns, using supportive pillows or pads, and posture corrections.
3. Weight control: Weight loss programs are implemented for overweight individuals to reduce the pressure of extra weight on the nerves and vessels.
4. Medication : Your doctor may prescribe medications to relieve pain, prevent clotting, or control inflammation.

Surgical treatment:

1. Costectomy: Surgery is sometimes necessary to correct problems caused by Thoracic Outlet Syndrome. A costectomy involves removing part of the first rib.
2. Muscle release: Releasing the muscles in the shoulder and neck area aims to reduce pressure on the nerves and vessels by allowing them to move more freely.
3. Complicated surgical interventions: In complicated cases, if necessary, the primary rib can be removed and a muscle release procedure can also be performed.

The treatment plan is determined by the severity, duration, and response of the patient's symptoms. Doctors generally prioritize conservative treatment methods and consider surgery when necessary. Treatment options should be tailored to the individual's specific situation, so it's important to consult a specialist to determine the most appropriate treatment plan.

Who gets thoracic outlet syndrome?

Thoracic Outlet Syndrome (TOS) is generally more common in individuals with certain risk factors. Some factors that increase the likelihood of TOS include:

• Age range: TOS is more common in adults between the ages of 20 and 50. This age group may be more susceptible to compression of the tissues surrounding nerves and blood vessels.
• Gender: TOS is more common in women than in men. This may be due to factors such as the influence of female hormones, genetics, and anatomical differences.
• Sports and exercise: Repetitive and strenuous sports that affect the arms, shoulders, and neck may increase the risk of TOS. Overuse in these areas, in particular, can affect the muscles and nerves.
• Anatomical defects: Congenital anatomical defects, particularly structural abnormalities affecting the neck and chest area, may increase the likelihood of developing TOS.
• Tumors and injuries: Tumors or traumatic injuries in the neck and chest area can cause compression of nerves and vessels, leading to TOS.
• Traffic accidents: Traumatic conditions, especially those resulting from traffic accidents, can contribute to the development of TOS by affecting the nerves and vessels.
• Pregnancy and obesity: Changes in the body during pregnancy and obesity can cause compression of nerves and blood vessels, increasing the risk of TOS.

While these factors increase the likelihood of TOS, a combination of factors may be necessary to determine whether an individual will develop TOS. If you experience symptoms of TOS or are experiencing risk factors, it's important to consult a healthcare professional.

Situations to consider after treatment for thoracic outlet syndrome (TOS)

• Weight management: If you are overweight or obese, losing weight can help relieve nerve or blood vessel compression. It's important to reach and maintain a healthy weight.
• Avoiding heavy loads: Avoiding repetitive lifting of heavy objects can reduce thoracic pressure. It's also important to use proper techniques before lifting heavy loads.
• Using lightweight bags: It's recommended to use lightweight bags for daily activities to reduce pressure on your shoulders and neck. Heavy bags can put extra pressure on the nerves and blood vessels in your shoulders and neck.
• Stretching exercises: Regularly stretching the chest, shoulders, and neck areas can help keep muscles flexible and reduce the likelihood of thoracic compression. Appropriate stretching routines can be established with the guidance of a physical therapist.
• Strengthening exercises: With your doctor's advice, physical exercises to strengthen the shoulder and chest muscles can be beneficial for correcting posture and supporting the neurovascular system.
• Regular monitoring and medication use: It's important to take your doctor's prescribed medications regularly and follow up regularly. Medications can help control pain and reduce inflammation.
• Stress management: Stress can trigger TOS symptoms. Learning and practicing stress management techniques can positively impact overall health.
• Ergonomic arrangements: Ergonomic arrangement of work environments such as desks and computer chairs can reduce potential posture problems caused by prolonged sitting or using computers.