Thoracic outlet syndrome (TOS) causes pain, pins and needles, numbness, and weakness in the shoulder, arm, and hand. The thoracic outlet itself is a small space where nerves and blood vessels pass between the rib cage and arm. Symptoms are slightly different if the compression involves nerves or blood vessels.
Mechanism of Thoracic Outlet Syndrome
The thoracic outlet (confusingly also known as the thoracic inlet) is the opening at the top of the rib cage. The passage in question in TOS is the space between the first rib, scalene muscles, and collar bone.
Nerves, arteries, and veins pass through the outlet, and any of them can become compressed or irritated. 95% of cases involve a nerve, 4% a vein, and 1% an artery. If the blood flow is significantly impacted, it can warrant urgent medical attention. Call 111 if your numbness is persistent, and your arm looks red or pale/blue, or is cold to the touch.
The case history will give us the majority of the information we need to develop a diagnosis. Your osteopath can use your pulse to see if the artery is involved.
Symptoms
The illustration above shows the areas most commonly affected by the symptoms of TOS. They can include:
- pain
- numbness
- weakness
- pins and needles
- changes in the colour of the skin if blood vessels are involved
- skin that is cold to the touch if the compression affects an artery
Other conditions can cause similar symptoms in the arm and shoulder. A nerve that is irritated closer to where it leaves the spinal cord can cause pins and needles, numbness, weakness, or pain in the arm. We have some clinical tests we can carry out to determine where the cause of your nerve symptoms are likely to be. Be sure to mention any problems with the neck or shoulder at your appointment. More vague pains may be down to a joint irritation in the neck.
Managing Thoracic Outlet Syndrome
Conservative treatment, like osteopathy, can help to avoid surgery for mild to moderate cases. The appropriate treatment plan would depend on the factors that have led to your case.
The thoracic outlet can be compressed when your shoulders are rounded or you are in a hunched position. These two positional factors can become more permanent if you adopt them for longer periods of time, such as while working at a desk or driving. In cases like these, the most beneficial course of action may be to address the areas of tightness and weakness that maintain the posture. Your osteopath can also give advice for making your desk position more appropriate. Treatment might take the form of hands on work to the upper back and shoulders, along with supportive exercises to stretch and strengthen.
The cause can also be traumatic rather than repetitive. A fractured collar bone, for example, could cause the same symptoms. If you do suspect a fracture, please see a doctor before visiting your osteopath.
