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What is Thoracic Outlet Syndrome (TOS)?

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Thoracic Outlet Syndrome is an unusual condition that occurs in less than 8% of the population. It affects women 4 times more frequently than men and is often found in younger overhead athletes. The condition is due to the compression of blood vessels and nerves in the region of the collar bone.Drawing showing nerves and muscles in the region of the collarbone relevant to Thoracic Outlet SyndromeThere are three subsets:

(a) Nerve compression is the most common (96%);

(b) Followed by the vein being compressed (3%); and finally

(c) 1% of the cases involve arterial compression.

The nerve compression category can be further divided into two groups named ‘true’ and ‘disputed’. Those falling into the ‘true’ category typically have symptoms in only one arm or hand and these symptoms are experienced mostly during the day. The ‘disputed’ category patients present with symptoms in both arms or hands and are more affected during the night.

Causes and symptoms of Thoracic Outlet Syndrome

The causes of the compression occurring in TOS include congenital factors such as abnormalities in the shape of the vertebrae or ribs, or unusual attachments of muscle. Acquired factors include posture habits, changes due to trauma and in some cases enlarged muscles in body builders.

Symptoms are varied and include neck pain, headaches, shoulder or arm pain, loss of fine motor skills, pins and needles, cold intolerance, changes of colour in the fingers and swelling in the hand or fingers.

Because the signs and symptoms are similar to a number of other conditions, such as compression of nerve at a spinal cord level, cervicogenic headaches or irritation of the rotator cuff muscles in the shoulder, the diagnosis of TOS is largely considered to be a diagnosis of exclusion. There are some tests that might help with diagnosis, however the literature shows that there can be a large variability in the accuracy and hence is no definitive diagnostic test.

Treatment is based on clinical findings and your physio will address what s/he finds during the assessment. This may include techniques to reduce muscle spasm and joint tightness. You will be given exercises to help improve the movement of the compressed nerve and muscle strengthening work.

If you are experiencing pain in the area of your collar bone, contact one of Lamberti’s physiotherapists using this online form, or else send us a message using WhatsApp.

References

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  2. Agata Maria Kaczmarek, Juliusz huber, Katarzyna Leszczynska, Paulina Wietrzak and Katarzyna Kaczmarek. Relationships between the Clinical Test Results and Neurophysiological Findings in Patients with Thoracic Outlet Syndrome. Bioengineering 2022, 9, 598. https://doi.org/10.3390/bioengineering9100598.

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