Thoracic Outlet Syndrome

The thoracic outlet syndrome (TOS) is a condition that involves the chest, neck and shoulder in which there is compression that affects nerves and vascular supply. The thoracic outlet is the area located between the collar bone and the rib cage. Pain is the result as well as tingling and numbness of the fingers.

There are generally three types of TOS. Vascular thoracic outlet syndrome is when there is compression of one or more veins or arteries under the collar bone.

Neurogenic thoracic outlet syndrome is characterized by the compression of the network of nerves that originate from the spinal cord and control muscle movements. This creates a negative sensation in the shoulder, arm and hand. Most thoracic outlet syndrome cases are neurogenic.

Common thoracic outlet syndrome is chronic pain in the thoracic outlet that worsens with activity. In fact, according to the Mayo Clinic in the U.S., some doctors believe it does not exist, while others say it's common.

Causes Of Thoracic Outlet Syndrome

The human body holds a vast network of blood vessels and nerves, many that come from the spine, and they pass through a narrow area near the collar bone and shoulder as they branch out into the arms. Sometimes as they pass through this area, there is not enough space. As a result, compression (pressure) on those blood vessels and/or nerves will produce symptoms in the hands and arms. Problems with the nerves are the root cause of all thoracic outlet syndrome cases.

This compression can be caused due to an abnormal tight band connecting the spinal vertebra to a rib or in rare cases, there is an extra cervical rib. Also, if an individual has been injured in that area or has overused the shoulder, they may experience TOS.

One other possible cause is that some people have weak (or droopy) shoulders or long necks and this creates extra pressure on the blood vessels and nerves.

Thoracic Outlet Syndrome Symptoms & Diagnosis

As mentioned above, pain is felt in the thoracic area and there can be tingling and numbness of the fingers. Also, when lifting an item, the arm may look pale due to intense pressure on the blood vessels.

A health professional must perform a physical examination and often ask about the patient’s history. Some tests that may be required include an MRI, CT angiogram, and x-ray, EMG (electromyography) or a nerve conduction velocity study. While conducting these tests, there is often a check to ensure there are no other presenting problems such as damaged nerves in the neck or carpal tunnel syndrome.


TOS affects the nerves and the first line of treatment is physical therapy – always. Physical therapy is required to strengthen should muscles, improve range of motion, and it promotes better posture. In more severe cases, pain medication may be discussed with the patient. Depending on the health professional, some will give their patient blood thinners to help reduce any swelling that may be present.

Only in very severe cases will surgery be considered. Surgery is invasive and Chiro-Med Rehab Centre strongly feels that this must always be a last resort option.

If you feel are experiencing any TOS symptoms, Chiro-Med Rehab Centre has a walk-in clinic conveniently located at 10144 Yonge Street, just north of Major MacKenzie Drive in the heart of Richmond Hill. The health professionals at Chiro-Med are available to help you with the least invasive methods possible. Call 905-918-0419 for more information or to book a consultation.

March 10, 2014

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