Is this the cause of the pain in your neck, shoulders, and arms? Let's learn about Thoracic Outlet Syndrome.

Do you sometimes feel a strange pain or numbness that radiates from your neck and shoulder down your arm? Does this pain seem to get worse when you raise your arm? Many people think this is normal, or that it's just a small vein in your neck being squeezed, but the cause may be a little more complicated than you think. Today we're going to talk about a condition that can cause similar symptoms, but many people haven't heard of it. That's Thoracic Outlet Syndrome (TOS).

Simply put, what is Thoracic Outlet Syndrome (TOS)?

This name may sound a bit complicated. But let's keep it simple. Imagine that there is a small tunnel-like space between our neck and chest. To be precise, the space below the collarbone and above the first rib. This space is what we call the 'thoracic outlet' in medicine.

This tunnel is very important because a major bundle of nerves that provides sensation and movement to our arm (called the brachial plexus ), as well as the main artery that supplies blood to the arm ( the subclavian artery ), and a major vein that carries blood from the arm back to the heart ( the subclavian vein ) pass through this small space.

Normally, these nerves and blood vessels can travel through this space without any obstruction. But what if this tunnel becomes blocked for some reason? That is, what happens if these nerves or blood vessels are compressed by the surrounding muscles, bones, etc.? That is what we call Thoracic Outlet Syndrome (TOS) . This compression is what causes many symptoms such as pain, numbness, and swelling in the arm.

Are there main types of TOS?

Yes, TOS is divided into three main types depending on what is causing this pressure. Knowing this exactly is very important for treatment.

Both the venous and arterial types are collectively known as Vascular Thoracic Outlet Syndrome . Both types usually require surgery. However, the more common Neurogenic type often responds well to physical therapy.

What are the symptoms of TOS?

Symptoms depend on whether the nerve or blood vessel is compressed. These symptoms are usually seen on one side (neck, upper chest, shoulder, arm, or hand).

Commonly seen symptoms:

• Pain: This pain may increase when you raise your arm. Some people may feel this as a mild pain.
• Numbness: A "pins and needles" sensation, similar to the feeling when your hand is numb.
• Numbness: Loss of sensation in some areas of the hand.
• Weakness: Decreased strength in the hand or fingers, difficulty gripping objects.
• Swelling or heaviness: The arm may swell and feel heavy, especially when the vein is constricted.
• Skin color changes: The hand may become pale or blue.
• Cold hands: When the artery becomes narrowed and blood flow is reduced, the hand may become colder than the other hand.
• Delayed healing of finger wounds: This may be due to poor blood circulation.

Could this pain be related to a heart attack?

This is a very important question. Because TOS can cause pain in the upper chest, some may be afraid that this is a heart attack or angina. However, there are clear differences between the two.

• TOS pain: Usually gets worse when you lift the affected arm . This pain does not get worse when you walk or exercise.
• Angina pain: This is pain caused by not getting enough blood to the heart. It usually gets worse during exertion, such as walking or climbing stairs . It gets better when you rest. It can also be accompanied by symptoms such as shortness of breath and sweating.

Similarly, weakness on one side of the body can be a symptom of a stroke. However, a stroke can also cause symptoms such as drooping of the mouth on one side, difficulty speaking, and changes in vision.

What causes TOS?

Doctors divide the causes of TOS into three main categories.

Sometimes, even if there is a congenital risk (e.g., an extra rib), symptoms may not appear until an accident or long-term improper activity.

Is this a serious condition? What will happen if it is not treated?

Yes, TOS can cause serious complications if left untreated, especially in the form of blood vessel constriction.

• Thrombosis: Blood clots can form in the arm due to narrowing of the veins. If this blood clot breaks loose and lodges in the lungs, it can cause a serious, life-threatening condition called pulmonary embolism .
• Chronic swelling and pain: Persistent swelling and pain in the hand.
• Tissue death (Gangrene): If an artery becomes blocked and blood flow to the hand is completely cut off, tissue in the fingers can die.
• Non-healing wounds: Wounds on the fingers may not heal due to poor blood circulation.
• Permanent nerve damage: Prolonged compression of nerves can cause permanent damage.

How does a doctor diagnose TOS?

Diagnosing TOS can sometimes be a bit challenging because the symptoms can be similar to those of many other conditions. Your doctor will first ask you about your symptoms and examine you.

During this physical examination, the doctor will ask you to perform certain movements. For example:

• Raise your arms up and ask them to flex and extend their palms (Elevated Arm Stress Test).
• They ask you to turn your neck in different directions.

The doctor can get an idea of ​​this by observing whether you experience symptoms such as pain or numbness when performing these movements, and how they occur.

In addition, the following tests may be ordered to confirm the diagnosis and rule out other conditions:

• Chest X-ray: Check for an extra rib (cervical rib).
• CT scan or MRI scan: To see exactly where the structures of the neck and chest are compressed, as well as the nerves and blood vessels.
• Electromyography (EMG) / Nerve Conduction Study: Checks nerve function and damage.
• Angiography (MRA or CT Angiography): To check the blood flow in the blood vessels and whether there is any blockage or blood clot.

What are the treatments for TOS?

Treatment depends on the type of TOS you have, the severity of your symptoms, and the cause.

1. Physical Therapy: This is the first and most important treatment for Neurogenic TOS. A physical therapist will teach you specific exercises to strengthen the muscles in your neck and shoulders, increase flexibility, and help you maintain proper posture. For many people, this treatment can significantly reduce symptoms.

2. Medicines:

• Painkillers: Your doctor may recommend painkillers such as NSAIDs to control pain.
• Anticoagulants: If blood clots have formed in the blood vessels or are at risk of forming, blood-thinning medications are given. Sometimes, special injections (thrombolytic therapy) may be given to dissolve the clot.

3. Surgery:

• Arterial and venous TOS (types of blood vessel constriction) often require surgery because of the high risk of serious complications.
• Surgery is also considered for patients with Neurogenic TOS who do not respond to physical therapy treatments.
• Surgery involves removing the cause of the compression of nerves or blood vessels. For example, removing an extra rib or cutting a tight muscle (decompression surgery).

Your doctor will explain to you in detail whether you need surgery, what it involves, and what the risks are.