Are you experiencing pain or numbness in your neck, shoulders, or arms? Could it be Thoracic Outlet Syndrome (TOS)?

Do you sometimes feel pain or numbness that starts in your neck and shoulders and goes down your arm? Perhaps this pain is worse when you raise your arm. It can be very annoying when you lift something heavy or do everyday tasks. Although many people think that this is a normal neck pain or sprain, it may be due to a condition that we don't talk about much, but affects many people. Today, let's talk about thoracic outlet syndrome , or TOS as doctors call it.

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

Imagine, there is a very narrow space between our neck and upper chest, specifically below the collarbone and above the first rib. This space is what we call the `Thoracic Outlet`. Through this narrow space, the main nerves and blood vessels ( blood vessels and veins) that go to our arms pass. It's like a lot of cars going down a narrow road.

Now imagine, what happens if this narrow space becomes even narrower or tighter for some reason? The nerves and blood vessels that run along that path start to get squeezed and blocked. The combination of symptoms like pain, swelling, and numbness caused by that squeezing is what we call Thoracic Outlet Syndrome (TOS) .

Are there main types of TOS?

Yes, TOS is divided into three main types depending on what is causing this pain. It's important to know this, because treatment varies depending on the type.

What are the symptoms of TOS?

Symptoms are mainly felt in your hands and wrists. Some symptoms may vary slightly depending on the type.

• Neck, shoulder, or arm pain : This is the main symptom. The pain increases when you raise your arm.
• Numbness and tingling: You may feel this tingling sensation, especially in your fingers and palms.
• Hand weakness: Difficulty lifting weights or holding something firmly.
• Swelling of the hand : This can be seen especially in the venous type.
• Hand color changes: The hand may turn blue, red, or pale. This indicates that blood flow is impaired.
• Cold palms: The palm of the affected hand may be colder than the other hand.
• A painful lump near the collarbone : You may be able to feel this yourself.
• Muscle Atrophy: If the pressure continues for a long time, some of the muscles in the hand, especially the muscles at the base of the big toe, may shrink and appear to have shrunk. This is also called ``Gilliatt-Sumner hand''.
• Weak pulse in the arm: In the arterial type, the pulse in the affected arm may be weak or absent when palpated.

What are the causes and risk factors for developing TOS?

There may be several reasons for this.

• Injuries: Neck injuries such as whiplash from a car accident, or injuries such as a broken collarbone can cause scar tissue and swelling to further narrow the space.
• Poor posture: This is a very important cause. When you are constantly hunched over and your shoulders are hunched forward (especially when you are in front of a computer or looking at your phone), your collarbone can drop slightly, pinching nerves and blood vessels. Weak shoulder muscles are also a cause of this.
• Repetitive stress: People who repeatedly perform repetitive movements with their arms raised are at higher risk. For example, swimmers, those who play sports like baseball, painters, and factory workers.
• Congenital abnormalities: Some people are born with an extra rib (cervical rib) in their neck. This can also narrow the space.
• Obesity: As body weight increases, the pressure on the collarbone and surrounding muscles increases. This is also a cause of snoring.
• Pregnancy: During pregnancy, the body's joints become loose. With this looseness, the collarbone may move and cause a sprain.
• Other causes: Tumors in the upper chest or armpit, excessive stress, and depression can also sometimes be a factor.

How does a doctor find this?

When you go to see a doctor, he will first ask you a detailed question about your symptoms and then perform a physical examination.

The neurogenic type is sometimes difficult to diagnose because its symptoms can be confused with other conditions that cause numbness and pain in the hand, such as carpal tunnel syndrome, arthritis in the neck and back, and other nerve compressions. Therefore, the doctor has to consider all of these factors to find the exact cause.

However, the symptoms of venous and arterial types (swelling, discoloration) are clear and can be identified quickly.

The following tests can be used to confirm the diagnosis:

• Positioning tests: The doctor will move your arms and head into different positions to see if your symptoms are getting worse or worse.
• Scalene muscle block: An anesthetic injection into a muscle in the neck. This is done to see if the pain goes away. If the pain goes away, it is likely that the problem is there.
• Imaging tests: An X-ray, CT scan, or MRI can check for birth defects, such as an extra rib. An ultrasound can check for blood vessel blockages.
• Nerve tests: These help to rule out other neurological conditions.
• Blood circulation tests: X-ray tests that use a special dye, such as an arteriogram or venogram, can accurately detect blood clots or damage to blood vessels.

What are the treatments for TOS?

Treatment options depend on the type of TOS you have.

For Neurogenic TOS:

This most common type usually does not require surgery.

• Physical therapy: This is the most important treatment. It involves exercises that strengthen and stretch the muscles in your neck and shoulders. It also helps you correct your posture. Many people find this to be very helpful.
• Medication: Painkillers like `Ibuprofen` or `Naproxen` (doctors also call these `NSAIDS`) and muscle relaxants can be given to reduce pain and swelling.
• Botox Injections: Injecting a Botox injection into a muscle at the base of the neck can relax the area and reduce pain. The effects last for approximately 3 months.

For Venous and Arterial TOS:

These two types usually require surgery.

• First, if there is a blood clot, it is treated.
• Then, a surgical procedure called a thoracic outlet decompression is performed. In this procedure, the surgeon opens up the space where the compression is. This may involve removing extra ribs, other tissue, or a portion of muscle that is causing the compression. They may also repair damaged blood vessels.

Things you can do at home

Doing these things along with treatment will give you even more relief.

• Maintain a healthy weight.
• Be mindful of your posture. Practice keeping your back straight at work and at home.
• Avoid carrying heavy bags on your shoulders.
• While working, always take a short break, get up, and stretch.
• Apply a heating pad to sore muscles. Get a massage.
• Do relaxation exercises to reduce stress.

What happens if TOS is left untreated?

It is very important to treat TOS as soon as possible. Otherwise, serious complications can occur, such as:

• Persistent pain and swelling in the hand
• Permanent nerve damage
• Conditions such as ischemic ulcers or gangrene in the fingers due to impaired blood flow
• Blood clots. If a blood clot breaks loose and blocks a blood vessel in the lungs, it is called a ``pulmonary embolism.`` This is a very serious, life-threatening emergency.

Thoracic Outlet Syndrome, TOS, Neck Pain, Arm Tingling, Shoulder Pain, Nerve Compression, Physical Therapy