Thoracic Outlet Syndrome

Thoracic outlet syndrome is a term used to describe three related syndromes involving the compression of nerves, arteries, and veins in the lower neck and upper chest area. The compression of one or more of these structures can result in pain through the arm, shoulder and neck. Compression of these structures occurs in one of the narrow passageways leading from the base of the neck to the armpit and arm, most commonly in the subclavian space (area under the collarbone).

The cause of the compression through these narrow passageways can vary greatly from person to person. Some of the causes may include; anatomical defects or variations, tumors within the narrow passageways, physical trauma, pregnancy, poor posture, & repetitive movements through the arm and shoulder.

The diagnosis of TOS can be complicated for all health professionals as there are many other injuries and conditions that have the same or similar symptoms, such as; rotator cuff injuries, cervical disc injuries/disorders, fibromyalgia, multiple sclerosis, complex regional pain syndrome, or tumors in the spinal cord. Along with the similarity of symptoms to other conditions, the symptoms of TOS can vary greatly in their severity – making the diagnosis even more complicated. To receive an accurate diagnosis, specialists will have to conduct nerve conduction studies, along with venous and arterial examinations under high-resolution imaging.

Neurogenic TOS

Neurogenic TOS is the compression of the nerve supply running through the subclavian space, resulting in neurological type symptoms running down the arm or in the hand, such as; pins & needles, numbness (paraesthesia), discoloration or temperature changes in the hand, or dull aching pain in the neck, shoulder, or armpit. Along with these symptoms, neurogenic TOS has one characteristic sign; the Gilliatt-Sumner hand. This is where there is severe muscle wasting through the thenar eminence (meaty part of the thumb).

Neurogenic TOS

Venous TOS Venous TOS is the compression of the venous blood supply running through the subclavian space, resulting in a weak or absent pulse through the affected arm, pale colouring of the arm (pallor), or being cool to the touch. Symptoms of venous TOS may include tingling, numbness, aching, weakness in the arm or neck, or swelling through the extremities – including the fingers.

Neurogenic TOS

Arterial TOS Arterial TOS is the compression of the arterial blood supply running through the subclavian space, resulting in poor blood circulation in the arm, hand and fingers of the affected arm, along with changes in color and cold sensitivity through the hand and fingers. Along with this, symptoms may include paraesthesias, heaviness, or swelling in the affected arm.

Symptoms

The symptoms of sciatic pain will vary between individuals, depending on the type of cause and the severity of the condition. The more severe the compression of the nerve the more severe the symptoms will be, and the greater chance the individual will suffer from multiple symptoms. Symptoms may include;

Intermittent or constant dull aching pain down the back or the outside of the leg. The distance down the leg the pain travels will vary depending on the individual; some people will only feel the pain into their glutes (bum), while others will feel the pain all the way through to the foot.
Numbness through the leg, not always directly associated with the pain felt in the back of the leg.
Some people will have feelings of a burning sensation, or tingling through their leg instead of the dull aching pain down the back of the leg that others may be feeling.
For some individuals there will be certain movements, postures, or positions that make their symptoms worse. The most common position is sitting.

Thoracic Outlet Syndrome

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