Thoracic Outlet Syndrome

Following a rear-end collision of 29 North in Albemarle County, one of our clients was diagnosed with a condition known as “Thoracic Outlet Syndrome.” Thoracic Outlet Syndrome occurs when the blood vessels and nerves in the thoracic outlet (which includes the space between the scalene muscles at the collar bone, down to the first rib) become compressed. In the case of our client, this resulted in severe shoulder pain as well as a tingling sensation in the hand and shoulder.

Thoracic outlet syndrome is commonly the result of physical trauma incurred in automobile accidents or sports related activities but can start without a trauma. Depending on the nature of the compression, Thoracic Outlet Syndrome can manifest in two specific forms. The first, neurogenic or neurological thoracic outlet syndrome, consists of the compression of the nerves in the thoracic outlet area, also known as the “brachial plexus.” The majority of TOS cases fall under this type.

The second type is vascular thoracic outlet syndrome which occurs when the subclavian vessels (the arteries and veins under the clavicle, or collar bone) are compressed. It is possible to have both nuerogenic and vascular thoracic outlet syndrome at the same time. A third type of Thoracic Outlet Syndrome develops in the form of non-specific thoracic outlet syndrome, but its existence in debated among medical experts and is marked by chronic plain the thoracic outlet area with no specific cause. Thoracic Outlet Syndrome is often diagnosed through exclusion. That is, after doctors have eliminated other causes such as a torn rotator cuff, or other shoulder area injuries, they may consider a diagnosis of Thoracic Outlet Syndrome.

The symptoms associated with Thoracic Outlet Syndrome can vary depnding on the type and severity of the case. However, common symptoms include:

  • Tingling in the fingers, or numbness
  • Neck and shoulder pain
  • Aches in the hand and arm
  • A weak grip
  • Bluish tint/discoloration of the hand
  • Subclavian vein thrombosis
  • Swelling of the extremities (often due to blood clots)
  • Painful lump near the collarbone
  • Lack of color in the hand and fingers
  • Tiny black spots (infarcts) on the fingers

Left untreated, Thoracic Outlet Syndrome can cause permanent damage to the nerves. Surgery for the condition is considered risky, and therefore, most doctors recommend a more conservative approach including but not limited to the use of Physical Therapy, relaxation techniques, and various mediciations such as pain relievers, muscle relaxers and anti-inflammatory drugs to decrease inflammation. If surgery is deemed necessary, the procedure involves the resection of the first rib to relieve compression. While surgery is the most effective treatment option for pain relief, it is not nearly as successful at treating muscle weakness, and a moderate decrease in usability can be expected.