Neurogenic Thoracic Outlet Syndrome (TOS) 

Most symptoms of thoracic outlet syndrome (TOS) are neurogenic.  The thoracic outlet is the space between the lower neck and upper chest. Neurogenic thoracic outlet syndrome (TOS) is characterized by the compression of the brachial plexus, or the system of nerves in the shoulder that control motor and sensory movements to the hands, shoulders and arms. It is the most common type of TOS, making up 96% of diagnoses. 

Causes of Neurogenic TOS 

An extra cervical rib or fractured collarbone can reduce the space available for nerves and blood vessels, resulting in TOS. Factors that can increase the risk of developing TOS include: 

  • Stress 
  • Depression 
  • Poor posture 
  • Sleep disorders 
  • A traumatic event, such as a car accident 
  • An injury to the neck or back 
  • Lifting heavy weights 
  • Repetitive injuries from carrying heavy objects 
  • Tumors or large lymph nodes in the underarm area or upper chest 
  • Pregnancy
  •  Repetitive shoulder or arm movement from playing sports, such as baseball, golf, swimming and others 

Symptoms 

Symptoms of thoracic outlet syndrome often include: 

  • Numbness or weakness of the hand  
  • Tingling, pain or a prickling feeling in the arms, chest and neck 

Diagnosis  

Physicians diagnose TOS after a complete physical examination and may refer patients for evaluation by a neurologist.  

Tests to diagnose TOS may include: 

  • Chest X-rays 
  • CT scans or an MRI of the spine or chest 
  • Blood tests 
  • Vascular studies 
  • Nerve conduction studies 
  • Arteriogram/venogram 

Treatment 

While TOS typically cannot be prevented, treatment options may include: 

Physical Therapy 

Physical therapy is the most common form of initial treatment for TOS. It strengthens muscles, promotes better posture and helps increase the range of motion of the shoulders and neck. Physical therapy exercises help relieve pressure on the nerves and blood vessels in the thoracic outlet. 

Over-the-Counter Medications  

Over-the-counter medications like aspirin, ibuprofen and Tylenol may be prescribed by a physician to help with inflammation and pain, as well as to encourage muscle relaxation. 

Surgery 

Surgery is only required for approximately 10-20% of TOS patients. The primary goal of surgery for TOS treatment is to eliminate compression on nerves and blood vessels. Surgery to remove part or all of a rib that may be the underlying cause of TOS is called decompression. Surgical complications may include nerve injury, bleeding, fluid leakage or a collapsed lung.  

The skilled physicians at Tampa General Hospital can help develop the best treatment plan for patients with neurogenic TOS. If left untreated, the condition can cause problems such as: 

  • Death of body tissue (necrosis) caused by loss of blood flow 
  • Permanent nerve damage 
  • Blood clots 
  • Permanent arm swelling and pain 
  • Ulcer(s) on the finger(s) due to decreased blood flow 
  • Blood vessel obstruction