Thoracic Outlet Syndrome

by Mark W. McFarland, DO
Pain in the shoulder and neck and numbness in the fingers can be caused by several conditions, but all have nerve or blood flow issues in common. One condition that can cause these symptoms is Thoracic Outlet Syndrome (TOS).  The thoracic outlet is the area in your upper body from your neck to your armpit.
There are three types of Thoracic Outlet Syndrome, but here, I will deal with the type that involves nerve compression of the brachial plexus and is the type seen most often, Neurogenic (neurological) thoracic outlet syndrome. The brachial plexus is a web of nerves that emerges from your spinal cord, responsible for controlling muscle sensation and movements in your hand, arm and shoulder.
TOS can be caused by a trauma, such as a high-impact fall or car accident, a repetitive-use injury (often seen in professional baseball pitchers), pregnancy, poor posture, obesity, congenital anatomical defects or for an idiopathic (unknown) reason.  Females are more likely than males to get it and the age range for development is 20-50 years of age.
The main symptoms are: tingling, numbness and pain in the neck, shoulder, arm and fingers; a weak grip and muscle wasting at the base of your thumb. Vascular types can cause color and temperature changes of the skin, among other symptoms.
Diagnosis can be difficult, because symptoms vary greatly and can mimic other conditions, such as fibromyalgia, complex regional pain syndrome or multiple sclerosis.  A physical examination and medical history will be important. X-ray, MRI, CT or Ultrasound can all be used to identify anatomical abnormalities.  Electromyography and nerve conduction studies can help identify nerve damage.
Treatment is essential for TOS, to prevent permanent nerve damage, and follows a conservative treatment path first.  Physical Therapy is the first thing I recommend, because learning and practicing correct posture daily, along with therapeutic stretching, can help to open the thoracic outlet and take pressure off of the compromised brachial plexus.  Pain, inflammation and muscle tension is controlled by non-narcotic pain medication, NSAIDs or steroid medications and muscle relaxants.
If symptoms do not resolve, surgery rarely may be necessary, and is usually only done for vascular issues or if there is an extra rib causing the compression.  We do not perform surgery for thoracic outlet syndrome here at OSC, but would refer you to MCV or UVA for surgical treatment.  A Neurosurgeon or vascular/thoracic surgeon would address issues, such as the removal of an extra rib, removal of tumors or the surgical release of areas which may be compressing nerves or blood vessels.
It is important to accurately diagnose and treat TOS so that appropriate treatment can be given quickly to prevent damage to nerves.