Thoracic Outlet Syndrome

Thoracic Outlet Syndrome Specialists
Thoracic outlet syndrome (TOS) is an umbrella term used to describe disorders caused by the compression, injury, or irritation of the nerves and blood vessels in the thoracic outlet, which is the area between your collarbone and your first rib. Dr. David L. Rollins, Dr. Vikram K. Rao, and the first-rate team at Northeast Ohio Vascular Associates (NEOVA) deliver treatment and surgery for TOS patients. From their state-of-the-art office in Willoughby, Ohio, they serve patients living in the Cleveland area.

Thoracic Outlet Syndrome Q & A

Northeast Ohio Vascular Associates

What are the symptoms of TOS?

Because TOS covers a variety of disorders that can affect a single area of your body, symptoms can vary greatly, depending on which structures (nerves, vessels, or both) are being compressed. The most common symptoms of TOS include:

  • Pain, numbness, or tingling in your shoulders, arms, and hands: usually getting worse with repetitive overhead movement
  • Cold fingers, hands, or arms
  • Swollen, easily fatigued, and discolored (with a blue tinge) arms and hands
  • Weak pulse (or no pulse) in the affected arm

If left untreated, thoracic outlet syndrome may lead to swelling, dysfunction, or loss of use of the affected extremity.

What causes TOS?

TOS has symptoms similar to many other conditions, including rotator cuff injury. TOS is caused by compression of the nerves, arteries or veins in the narrow passageway at the base of your neck into your arm. Common causes of such compression can include:

  • Physical trauma: From a car accident or another injury to the area
  • Repetitive injuries: Such as those that develop from job- or sports-related activities
  • Pregnancy
  • Poor posture
  • Obesity: Which can put extra pressure on your joints
  • Specific anatomical defect: Having an extra rib

When the brachial plexus nerve roots are compressed it's called neurogenic TOS which is initially treated using physical therapy and surgery which could involve removing the scalene muscles in the neck, or removal of the first rib, or both.

What are the treatment options for TOS?

TOS is more common in young adults, between 20 and 40 years of age, and tends to affect women more than men. The condition is usually addressed by using a combination of physical therapy with medical treatment and doesn’t usually cause any long-term effects. Anti-inflammatory medications can help decrease inflammation, while clot-dissolving medications can take care of any existing blood clots in the region, including subclavian vein blockages.

If physical therapy isn’t helpful, then decompression of the thoracic outlet by removing the first rib can be used to address the condition. Patients who have a blockage or clotting in the subclavian vein first require clot-busting drugs to remove the clot, followed by rib removal at a later date. Artery-related problems frequently require artery bypass as well as removal of the first rib.

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