1. What is Thoracic Outlet Syndrome?
2. What causes it?
3. What can I do about it?

WHAT IS THORACIC OUTLET SYNDROME?

The diagnosis of Thoracic Outlet Syndrome (TOS) is controversial. TOS represents a variety of symptoms affecting the arms and hands and may include pain, weakness, numbness, tingling, swelling, fatigue and/or sensation of cold. It is commonly seen in people who spend a significant amount of time on the computer or work overhead. TOS may at times be confused with other disorders. The onset, frequency, duration and pattern of symptoms in addition to a thorough examination may help your doctor determine if there is another problem or whether you may have TOS. Tests such as X-rays, CT, MRI and electro diagnostic studies can also assist in developing a more precise diagnosis.

WHAT CAUSES THORACIC OUTLET SYNDROME?

It is believed that TOS is caused by compression of the nerves and blood vessels as they exit the neck and chest. Symptoms will vary depending upon the type of structure compressed. Compression of the structures is usually related to muscle shortening in the neck and chest. This shortening may occur after violent neck trauma such as a car accident. The force of the trauma can tear the muscles and as the muscles begin to heal, scar tissue may form in the muscle, leading to compression of the nerves and blood vessels. Poor posture is also frequently associated with TOS. The nerves and vessels in the thoracic outlet area may become constricted by repetitive activities that require the arms to be held forward or overhead for extended periods.

WHAT CAN I DO ABOUT IT?

Treatment for TOS is usually conservative and does not require surgery. When conservative methods prove unsuccessful in alleviating symptoms, surgery can be offered as an option. There is no guarantee of success and surgery carries significant risks with variable outcomes.

Conservative treatment consists of physical therapy directed toward education about anatomy, the importance of correct posture and proper body mechanics, and specially designed exercises toward "decompressing" the thoracic outlet. Medication and/or procedural management are often used to minimize symptoms and make therapy more tolerable.

Performing a regular home program is critical and many weeks to months may be necessary to notice any significant difference. A well-designed workstation is also crucial. Sometimes this involves minor adjustments in the workstation design or the way in which one operates within the work environment. If symptoms persist despite these changes, one may need to consider alternative types of work tasks.

Some people may develop sleep disturbance, fatigue, sadness, decreased appetite, and/or anxiety. If these symptoms have a significant effect on your ability to function, it might be best to consider a coordinated program such as HELP. This program involves full day, daily participation over many weeks. It promotes fitness training, nutrition instruction, biofeedback therapy and counseling by a team of skilled professionals who work together with you and your family. The primary goal is to teach you how to best manage your condition over the long-term.